Mild to moderate pulmonary hypertension in liver transplantation

Patients with pulmonary hypertension (PHTN) are at increased risk for worse outcomes post-liver transplant (LT). This study evaluated LT outcomes and complications for a large number of LT patients with mild to moderate PHTN.

This is a retrospective review of data from 2001 to 2011. All cases of PHTN were diagnosed with catheterization (mean pulmonary artery pressure) and categorized according to standard criteria: low-mild, 25-29 mm Hg; high-mild, 30-34 mm Hg; moderate, 35-44 mm Hg; and severe, ≥45 mm Hg. Our center protocol excludes most patients with known moderate and severe PHTN from LT. Outcomes included early liver function, ventilator time, hospital length of stay, and graft and patient survival.

We reviewed the cardiac and pulmonary records for 1263 patients. There were 102 patients with confirmed PHTN (8%): 63 low-mild, 30 high-mild, and 9 moderate. Patients with PHTN were older (P < 0.001). Patients with PHTN were more likely to have prolonged post-transplant ventilator weaning (40% versus 26% >48 h post-transplant; P < 0.01) and a longer length of hospital stay (12 versus 10 d; P = 0.08). The PHTN had a lower 1-y graft survival (79% versus 87%; P = 0.05). There were no statistical differences in early graft function or in long-term patient survival.

These results suggest that PHTN patients require longer post-liver transplant ventilation and length of hospital stay, but have similar early graft function and long-term survival. The risk of PHTN in these patients increases with increasing age.