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Published on: March 1, 2022
Portopulmonary hypertension practice patterns after liver transplantation
Arun Jose1, Elizabeth J Kopras1, Shimul A Shah2
1Division of Pulmonary, Critical Care, and Sleep Medicine , University of Cincinnati , Cincinnati , Ohio , USA.
Physician practices for adjusting portopulmonary hypertension (POPH) therapy after liver transplantation (LT) vary significantly. Many providers prefer gradual adjustments, diverging from immediate post-LT therapy changes suggested by some guidelines.
Area of Science:
- Cardiology
- Hepatology
- Pulmonology
Background:
- Portopulmonary hypertension (POPH) is a severe complication of portal hypertension.
- Liver transplantation (LT) offers improved outcomes for POPH patients.
- Current guidelines recommend conservative adjustments to POPH therapy post-LT.
Purpose of the Study:
- To investigate current clinical practices for adjusting targeted therapy in POPH patients post-LT.
- To compare these practices with existing guidelines.
- To identify variations in therapeutic approaches among healthcare providers.
Main Methods:
- A cross-sectional, mixed-methods survey study was conducted.
- 85 US-based POPH physicians (pulmonologists and cardiologists) participated.
- Survey data on post-LT therapy adjustment practices were analyzed.
Main Results:
- Most providers (69%) adjusted parenteral prostacyclins gradually within 3 months post-LT.
- A significant minority (19.7%) adjusted therapy immediately after LT.
- The majority favored integrated cardiopulmonary testing, including right heart catheterization, for guiding therapy adjustments.
Conclusions:
- Significant heterogeneity exists in POPH management post-LT.
- Current practices deviate from some guideline recommendations.
- Further research and a team-based approach are needed to standardize care and optimize outcomes.
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