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Published on: November 18, 2018
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Sex Differences in Portopulmonary Hypertension.
Hilary M DuBrock1, Rodrigo Cartin-Ceba2, Richard N Channick3
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
Chest
|August 18, 2020
Summary
Female patients with portopulmonary hypertension (POPH) show higher pulmonary vascular resistance and better treatment response but worse survival in younger individuals. This highlights sex-based differences in POPH management and outcomes.
Area of Science:
- Cardiology
- Pulmonology
- Hepatology
Background:
- Portopulmonary hypertension (POPH) is a severe complication of portal hypertension, associated with high mortality.
- Female sex is a known risk factor for POPH, yet sex-specific clinical characteristics and outcomes remain understudied.
Purpose of the Study:
- To investigate sex-based differences in clinical presentation, hemodynamics, treatment efficacy, and survival among patients with POPH.
- To determine how age modifies the impact of sex on POPH outcomes.
Main Methods:
- Retrospective cohort study of 190 adult liver transplant candidates with POPH using the Organ Procurement and Transplantation Network database.
- Comparison of clinical characteristics, pulmonary hemodynamics (pulmonary vascular resistance - PVR), and survival between females and males.
- Multivariate regression and age-stratified analyses to assess the independent association of sex with PVR and survival.
Main Results:
- Females had lower MELD scores and higher baseline and post-treatment PVR compared to males.
- Women demonstrated a greater treatment response (ΔPVR) but similar overall survival.
- Female sex was independently associated with higher PVR and worse waiting list survival in younger patients (<50 years).
Conclusions:
- Sex influences POPH pathophysiology and treatment response, with females exhibiting higher PVR and better response but worse survival in younger populations.
- These findings underscore the need for sex-specific considerations in managing POPH, particularly in younger patients.
- Further research is warranted to elucidate the mechanisms behind these observed sex and age interactions in POPH.
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