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 D Winters, Seda B. Akinci, Sean P. Gaine

Research output: Contribution to journalArticle

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 - 2001

Fingerprint

Epoprostenol
Liver Transplantation
Hypertension
Pulmonary Artery
Right Ventricular Function
Vascular Resistance
Pressure
Vasodilator Agents
Early Diagnosis
Therapeutics
Hemodynamics
Lung

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Liver transplantation in patients with severe portopulmonary hypertension treated with preoperative chronic intravenous epoprostenol. / Tan, Henkie P.; Markowitz, Jay S.; Montgomery, Robert A.; Merritt, William T; Klein, Andrew S.; Thuluvath, Paul J.; Poordad, F. Fred; Maley, Warren R.; Winters, Bradford D; Akinci, Seda B.; Gaine, Sean P.

In: Liver Transplantation, Vol. 7, No. 8, 2001, p. 745-749.

Research output: Contribution to journalArticle

Tan, HP, Markowitz, JS, Montgomery, RA, Merritt, WT, Klein, AS, Thuluvath, PJ, Poordad, FF, Maley, WR, Winters, BD, Akinci, SB & Gaine, SP 2001, 'Liver transplantation in patients with severe portopulmonary hypertension treated with preoperative chronic intravenous epoprostenol', Liver Transplantation, vol. 7, no. 8, pp. 745-749. https://doi.org/10.1053/jlts.2001.26057
Tan, Henkie P. ; Markowitz, Jay S. ; Montgomery, Robert A. ; Merritt, William T ; Klein, Andrew S. ; Thuluvath, Paul J. ; Poordad, F. Fred ; Maley, Warren R. ; Winters, Bradford D ; Akinci, Seda B. ; Gaine, Sean P. / Liver transplantation in patients with severe portopulmonary hypertension treated with preoperative chronic intravenous epoprostenol. In: Liver Transplantation. 2001 ; Vol. 7, No. 8. pp. 745-749.
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AU - Montgomery, Robert A.

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AU - Klein, Andrew S.

AU - Thuluvath, Paul J.

AU - Poordad, F. Fred

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AB - 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.

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