Pulmonary vascular morphological changes in cirrhotic patients undergoing liver transplantation

Cirrhosis and portal hypertension may be associated with pulmonary hyperten sion and pulmonary dysfunction, However, morphological pulmonary vascular l esions in patients with cirrhosis have not been well characterized morphome trically. We morphometrically evaluated pulmonary vessels in liver transpla nt recipients with pretransplantation cirrhosis and correlated our findings with pretransplantation cardiopulmonary function, postoperative course, an d postmortem cardiopulmonary findings. Autopsy lung slides from 23 transpla nt recipients with pretransplantation cirrhosis were examined, External ves sel diameter, intimal thickness, and arterial medial thickness were measure d with a micrometer after pentachrome staining, The percent of total diamet er comprised by intima or media was calculated for each vessel, Medical rec ords were reviewed for smoking history, pretransplantation cardiopulmonary function testing, and postoperative course, Autopsy cases without liver or significant cardiopulmonary diseases, matched for age, sex, and smoking his tory, served as controls, Transplant recipients had significantly more pulm onary venous intimal thickening than matched controls (P <.0001). Sixty-fiv e percent (15 of 23) of these patients had some degree of pretransplantatio n pulmonary dysfunction, defined by abnormalities in pulmonary function tes ts, oxygen saturation, and/or increased pulmonary artery pressures, However , the severity of venous intimal thickening did not correlate with the seve rity of pretransplantation pulmonary dysfunction, Arterial intimal and medi al thickness were not statistically significantly different from controls, Pulmonary venous intimal thickening and resultant luminal impingement are m orphological findings not previously described in this population. The arte rial lesion, when present, is similar to that seen in pulmonary hypertensio n from other causes, These pulmonary vascular lesions may be implicated in pulmonary dysfunction in patients with cirrhosis and may be associated with increased posttransplantation cardiopulmonary morbidity and mortality, Cop yright (C) 1999 by the American Association for the Study of Liver Diseases .