Liver transplantation in patients with severe portopulmonary hypertension treated with preoperative chronic intravenous epoprostenol

Henkie P. Tan, Jay S. Markowitz, Robert A. Montgomery, William T. Merritt, Andrew S. Klein, Paul J. Thuluvath, F. Fred Poordad, Warren R. Maley, Bradford Winters, Seda B. Akinci, Sean P. Gaine

Research output: Contribution to journalArticlepeer-review

65 Scopus citations

Abstract

Portopulmonary hypertension (PPHTN) is no longer an absolute contraindication to orthotopic liver transplantation (OLT). The pre-OLT management of patients with PPHTN requires early diagnosis and chronic therapy with intravenous epoprostenol to decrease pulmonary vascular resistance (PVR). Close follow-up is necessary to reassess pulmonary artery pressures (PAPs) and evaluate right ventricular (RV) function. This assists in the optimal timing of OLT. Successful management also necessitates reassessment of pulmonary artery hemodynamics just before OLT, with clearly defined parameters used to determine whether to proceed. Even with the intraoperative and postoperative availability of potent pulmonary vasodilators, clinical management may be suboptimal in reducing PAP. Adequate reduction in PVR and improvement in RV function in response to chronic epoprostenol therapy may facilitate successful OLT. We present a case report and review the limited experience with this treatment.

Original languageEnglish (US)
Pages (from-to)745-749
Number of pages5
JournalLiver Transplantation
Volume7
Issue number8
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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