Huang Bingsong, Shi Yi, Liu Jun, Schroder Paul M, Deng Suxiong, Chen Maogen, Li Jun, Ma Yi, Deng Ronghai
Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
Department of Respiratory, the First People's Hospital affiliated to Guangzhou Medical University, Guangzhou, 510080, China.
BMC Gastroenterol. 2018 Jun 7;18(1):79. doi: 10.1186/s12876-018-0797-8.
Portopulmonary hypertension (PPH) was once regarded as a contraindicaton to liver transplantation (LT). However, growing evidence has indicated that PPH patients undergoing LT may show similar outcomes compared to those without PPH, and researchers have recommended it not be an absolute contraindication. Given this controversy, we aimed to identify and review the current evidence on this topic and to provide a comparison of the outcomes after LT between candidates with PPH and those without.
We systematically searched the MEDLINE, EMBASE and Cochrane Library databases for all studies that compared the outcomes of PPH patients and those without PPH after LT. All studies reporting outcomes of PPH patients versus those without PPH (Control) were further considered for inclusion in this meta-analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to compare the pooled data between PPH and Control groups.
Eleven retrospective trials and one prospective, randomized, controlled trial, involving 37,686 transplant recipients were included. The PPH patients had increased 1-year mortality with an OR of 1.59 (95% CI = 1.26-2.01, P = 0.0001) compared to the control group. There was no significant difference in graft loss and 30-day mortality after LT between the two groups.
Patients with PPH who underwent LT had increased 1-year mortality compared to those without PPH, while graft loss and 30-day mortality were similar. Nevertheless, LT may be a reasonable therapeutic option for some patients with PPH, but further studies are needed to identify those select patients with PPH who would benefit most from LT.
门肺高压（PPH）曾被视为肝移植（LT）的禁忌证。然而，越来越多的证据表明，接受LT的PPH患者与未患PPH的患者相比，可能有相似的预后，并且研究人员建议它不应成为绝对禁忌证。鉴于这一争议，我们旨在识别和回顾关于该主题的现有证据，并比较PPH候选患者和非PPH候选患者LT后的预后。
我们系统检索了MEDLINE、EMBASE和Cochrane图书馆数据库，以查找所有比较LT后PPH患者和非PPH患者预后的研究。所有报告PPH患者与非PPH患者（对照组）预后的研究都进一步被考虑纳入该荟萃分析。计算优势比（OR）和95%置信区间（CI），以比较PPH组和对照组之间的汇总数据。
纳入了11项回顾性试验和1项前瞻性随机对照试验，涉及37686名移植受者。与对照组相比，PPH患者1年死亡率增加，OR为1.59（95%CI = 1.26 - 2.01，P = 0.0001）。两组LT后移植物丢失和30天死亡率无显著差异。
与未患PPH的患者相比，接受LT的PPH患者1年死亡率增加，而移植物丢失和30天死亡率相似。尽管如此，LT可能是一些PPH患者的合理治疗选择，但需要进一步研究以确定哪些特定的PPH患者将从LT中获益最大。
