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Multivisceral Transplant in a Patient With Portopulmonary Hypertension: A Case Report
J Livingstone1, Y Raveh1, F Souki1
1Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida.
Transplantation Proceedings
|August 1, 2022
Summary
Portopulmonary hypertension management is critical for transplant candidates. This case study highlights a successful multivisceral transplant in a patient with severe portopulmonary hypertension, demonstrating effective perioperative strategies.
Area of Science:
- Cardiology
- Hepatology
- Transplant Surgery
Background:
- Portopulmonary hypertension (POPH) significantly increases risks for liver transplant recipients.
- Uncontrolled POPH can disqualify patients from transplantation, despite poor prognosis without it.
Observation:
- A 29-year-old woman with a history of liver transplant and biliary atresia developed portal vein thrombosis and POPH.
- She underwent a complex multivisceral transplant (liver, stomach, pancreas, small and large intestine).
Findings:
- Preoperative pulmonary artery pressure was managed with sildenafil and epoprostenol.
- Intraoperative care involved transfusion protocols and medications like epoprostenol, sildenafil, milrinone, and inhaled nitric oxide to manage hemodynamics.
- Careful balancing of anticoagulation and thrombosis prevention was crucial due to POPH and coagulopathy.
Implications:
- This case demonstrates the feasibility of multivisceral transplantation in patients with severe POPH.
- Multimodal and multidisciplinary management is key to successful outcomes in complex transplant scenarios.
- Effective perioperative strategies can mitigate risks associated with POPH during major abdominal transplantation.
