Mae. Ramsay et al., NITRIC-OXIDE DOES NOT REVERSE PULMONARY-HYPERTENSION ASSOCIATED WITH END-STAGE LIVER-DISEASE - A PRELIMINARY-REPORT, Hepatology, 25(3), 1997, pp. 524-527
Pulmonary hypertension is a well known, though uncommon complication o
f end-stage liver disease (ESLD). Patients with severe pulmonary hyper
tension and ESLD undergoing orthotopic liver transplantation (OLT) may
develop right ventricular failure and death. This study investigates
the reversibility of pulmonary hypertension by the inhalation of nitri
c oxide in patients under evaluation for OLT. Ten patients with ESLD w
ho were discovered to have moderate to severe pulmonary hypertension w
ere administered nitric oxide via face mask in concentrations ranging
from 0 to 80 ppm. Inhaled nitric oxide is a potent pulmonary vasodilat
or without apparent systemic effects. Nitric oxide had no demonstrable
effect on mean pulmonary artery pressure (PAP) (37 vs. 37 mm Hg), tra
nspulmonary gradient (TPG) (26 vs. 26 mm Hg), or pulmonary vascular re
sistance (PVR) (295 vs. 288 dynes . sec . cm(-5)). Two patients were d
iscovered to have an elevated pulmonary artery occlusion pressure (PAO
P) on baseline readings. The cause of pulmonary hypertension in these
two patients was secondary to volume overload as a result of hepato-re
nal syndrome rather than primary pulmonary arteriolar pathology and wa
s responsive to diuresis or dialysis but not to nitric oxide therapy.
In conclusion nitric oxide does not reverse pulmonary hypertension ass
ociated with ESLD.