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Related Concept Videos

Pulmonary Hypertension: Classification and Pathogenesis01:30

Pulmonary Hypertension: Classification and Pathogenesis

902
Pulmonary hypertension (PH) is a severe health condition in which the mean pulmonary arterial pressure increases to 25 mmHg or more, even when the body is at rest. This high pressure in the blood vessels that transport blood from the heart to the lungs can cause various symptoms, including shortness of breath, can lead to right heart failure, and significantly affect the overall quality of life.
There are various classifications for PH, each relating to different underlying causes and also...
902
Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists01:23

Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists

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Prostacyclin receptor agonists are a class of therapeutic agents integral to managing pulmonary arterial hypertension (PAH). These drugs operate by mimicking the action of prostaglandin I2, or PGI2, a naturally occurring compound in the body.
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
611
Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists01:18

Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists

611
Endothelins (ETs) are potent vasoactive peptides critical in the human body's various physiological and pathological processes. One of the most promising therapeutic strategies for treating pulmonary arterial hypertension (PAH) involves counteracting the effects of these endothelins using a class of drugs known as endothelin receptor antagonists.
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
611
Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure01:16

Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure

815
Oxygen therapy has emerged as a significant tool in enhancing the quality of life for patients suffering from pulmonary arterial hypertension (PAH). While this therapy has principally been studied on patients with significant hypoxemia, this therapeutic approach helps prevent potential organ damage and can be administered in the comfort of one's home.
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue,...
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Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers01:26

Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers

688
Receptor tyrosine kinase inhibitors (TKIs) and calcium channel blockers (CCBs) are two critical categories of drugs employed in the treatment of pulmonary artery hypertension (PAH). PAH is a disease that causes high blood pressure in the pulmonary arteries, resulting in chest pain, fatigue, and shortness of breath.
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
688
Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors01:28

Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors

818
Phosphodiesterase 5 (PDE5) inhibitors are potent enzymes that function to hydrolyze cyclic nucleotides to their corresponding 5' monophosphates. Their unique biochemical properties have been applied in treating Pulmonary Arterial Hypertension (PAH).
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
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Updated: Apr 27, 2026

Increasing Pulmonary Artery Pulsatile Flow Improves Hypoxic Pulmonary Hypertension in Piglets
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MELD exceptions for portopulmonary hypertension: current policy and future implementation.

D S Goldberg1, S Batra, S Sahay

  • 1Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|July 3, 2014
PubMed
Summary

The portopulmonary hypertension (POPH) exception policy for liver transplant waitlists needs review. Many patients approved for POPH MELD exception points did not meet criteria, yet had increased mortality risk.

Keywords:
Clinical researchUnited Network for Organ Sharing (UNOS)editorialorgan allocationorgan procurement and allocationpersonal viewpointpractice

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Area of Science:

  • Transplantation immunology
  • Cardiology
  • Hepatology

Background:

  • Liver transplant candidates with portopulmonary hypertension (POPH) have been eligible for Model for End-Stage Liver Disease (MELD) exception points since 2006.
  • The effectiveness and implementation of this POPH exception policy remain unevaluated.

Purpose of the Study:

  • To evaluate the outcomes of liver transplant waitlist candidates with approved POPH MELD exceptions.
  • To assess the adherence to formal criteria and hemodynamic parameters for POPH MELD exceptions.

Main Methods:

  • Utilized data from the Organ Procurement and Transplantation Network (OPTN) from 2006 to 2012.
  • Compared outcomes of patients with approved POPH MELD exceptions to non-exception waitlist candidates.
  • Employed multivariable multistate survival models to analyze mortality risk.

Main Results:

  • 155 patients received POPH MELD exceptions, but only 47.1% met formal OPTN criteria.
  • Over one-third lacked consistent hemodynamic criteria or had missing data, yet 80% received transplants.
  • POPH MELD exception recipients faced increased mortality risk compared to non-exception candidates (HR: 2.46 with criteria; HR: 1.60 without).

Conclusions:

  • The current POPH MELD exception policy and its awarding process require reconsideration by OPTN/UNOS.
  • Inconsistent application of criteria and potential biases in the exception point system may impact patient outcomes.