MODERATE PRIMARY PULMONARY-HYPERTENSION IN PATIENTS UNDERGOING LIVER-TRANSPLANTATION

Primary pulmonary hypertension (PPH) in patients with hepatic cirrhosi s is often considered an unacceptable condition for liver transplantat ion because of increased morbidity and mortality during the procedure. We studied the incidence, characteristics, and final outcome of patie nts with PPH undergoing liver transplantation in our institution. Amon g the 226 patients undergoing 257 Liver transplantations, eight (3.5%) fulfilled the conditions of PPH and responded to vasodilator therapy. Nitroglycerin 1.5 mu g/kg produced a decrease in pulmonary vascular r esistance index (PVRI) and mean pulmonary arterial pressure (MPAP) of 20% and 15%, respectively. Patients with PPH when compared with a matc hed group of patients without PPH had markedly increased hemodynamic c hanges in PVRI (P = 0.004) and MPAP (P = 0.0001) during and after the procedure. All patients with PPH required pulmonary vasodilator therap y after reperfusion of the new Liver, while none in the group of patie nts without PPH required this therapy. Furthermore, after graft reperf usion, patients with PPH in which venovenous bypass was not used (n = 3), had a more compromised right ventricular function with a greater i ncrease of central venous pressure (CVP) (90%) and MPAP (140%) when co mpared with patients with bypass or preservation of the recipient's ve na cava (n = 5) in whom the increase of CVP and MPAP was 50% and 60%, respectively. Moderate PPH without a fixed level of pulmonary hyperten sion in patients undergoing liver transplantation is not related to an adverse outcome.