*Purpose: Portopulmonary hypertension (POPH) refers to pulmonary artery hypertension (PH) as a consequence of portal hypertension with or without liver disease. Previous studies used pulmonary arterial-specific medication (PHM) to improve outcome after LT. However, detailed outcome after LT was not well known regarding pulmonary hemodynamics or medications. We summarized outcome of LT recipients with POPH in our center.

*Methods: Retrospective analysis was conducted among LT recipients between 2002 and 2021, who fulfilled diagnostic criteria of right heart catheterization (RHC): mean pulmonary pressure (mPAP) of greater than 25 mmHg, pulmonary vascular resistance (PVR) of greater than 3 wood units. Data collection included cardiac echo, RHC, pharmacotherapy, and patient survival.

*Results: POPH was classified as mild, moderate, or severe based on mPAP of <35mm Hg, 35-49mm Hg, and 50mmHg, respectively. Eleven LT recipients with POPH were identified (4 mild, 4 moderate, 3 severe). The median chemical MELD score was 18, the median estimated right ventricular systolic pressure (RVSP) in echocardiography was 6251.85 mm Hg (22 - 63), the median mPAP was 41.7 mm Hg (32 - 53), and the median pulmonary vascular resistance (PVR) was 3.0 wood units (2.6 - 10.8). All the POPH recipients received PHMs before LT to optimize mPAP and PVR. One recipient died during LT because of acute heart failure. Survival rates were 72.7% after a median follow-up of 1475 days. After LT, the median RVSP was 39 mm Hg (27 - 106). And 4 recipients developed elevated mPAP (47 - 70 mm Hg) requiring increased PHMs, 6 recipients were stable on PHMs, and 1 recipient was weaned off PHM.

*Conclusions: Recipients with POPH had favorable survival as PHMs optimized mPAP and PVR. However, POPH was not reversed by LT alone in most cases. POPH in isolation, without other hepatic cirrhosis-related complications, should not be an indication for LT.

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