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Favorable Post-Transplant Survival for Liver Transplant Recipients with Treated Porto_Pulmonary Hypertension

R. Salgia, N. Goodrich, R. Merion, P. Sharma

Division of Gastroenterology, University of Michigan, Ann Arbor, MI
Arbor Research Collaborative for Health, Ann Arbor
Surgery, University of Michigan, Ann Arbo

Meeting: 2013 American Transplant Congress

Abstract number: D1633

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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.

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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 January 18, 2021.

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