Background: Portopulmonary hypertension (PPH) was once considered an absolute contraindication for liver transplantation (LT) because of associated high peri- and postoperative mortality rates. With evolution of treatment with prostacyclin inhibitors and phosphodiesterase inhibitors, PPH has become a more accepted LT indication with MELD exception. An exception MELD score of 22 is assigned to candidates with documentation of effective treatment (mean pulmonary artery pressure < 35 mmHg and pulmonary vascular resistance < 400 dynes/sec/cm-5). Published data on post-LT outcomes for candidates with PPH are based on case series and single center studies. We examined the post-transplant outcomes of patients who received LT for PPH in the MELD era.
Methods: Scientific Registry of Transplant Recipients data on 34296 adult (≥18 years) deceased donor LT recipients transplanted between 3/1/2002 and 10/31/2010 were reviewed. Recipients of living donor LT, re-LT, multi-organ transplant, and status-1 were excluded. The diagnosis of PPH was ascertained from MELD exception forms. Patients were followed from the time of transplant until the earlier of death or end of the follow-up period. The primary outcome was patient survival. Kaplan-Meier analysis was used to compare unadjusted post-transplant survival. Cox regression was used to test for an association between PPH exception and risk of mortality, adjusted for recipient and donor factors.
Results: During the study period, 78 recipients received a pre-transplant exception for PPH. Unadjusted 1-, 3-, and 5-year patient survival for PPH was not different than all other adult candidates who did not receive exception points (PPH: 85%, 81%, and 73%; all non-exception: 88%, 79%, and 73%; log-rank p=0.65). In a Cox model adjusted for numerous recipient and donor factors, PPH was not a significant predictor of post-LT mortality (HR=1.49, p=0.11).
Conclusions: This is the largest study to demonstrate that post-transplant survival for LT recipients with treated PPH is similar to that of other LT recipients.
To cite this abstract in AMA style:Salgia R, Goodrich N, Merion R, Sharma P. Favorable Post-Transplant Survival for Liver Transplant Recipients with Treated Porto_Pulmonary Hypertension [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/favorable-post-transplant-survival-for-liver-transplant-recipients-with-treated-porto_pulmonary-hypertension/. Accessed October 29, 2020.
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