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Does Portopulmonary Hypertension Impede Liver Transplantation in Cirrhotic Patients? A French Multicentric Retrospective Study

Reymond, Maud, MD1; Barbier, Louise, MD2,3; Salame, Ephrem, MD, PhD2,3; Besh, Camille, MD4; Dumortier, Jérome, MD, PhD5; Pageaux, Georges-Philippe, MD, PhD6; Bureau, Christophe, MD, PhD7; Dharancy, Sébastien, MD, PhD8; Vanlemmens, Claire, MD9; Abergel, Armand, MD, PhD10; Woehl Jaegle, Marie-Lorraine, MD4; Magro, Pascal, MD11; Patat, Frederic, MD, PhD12; Laurent, Emeline, MD13; Perarnau, Jean-Marc, MD1

doi: 10.1097/TP.0000000000001981
Original Clinical Science—Liver

Background Portopulmonary hypertension is defined by the presence of pulmonary arterial hypertension associated with portal hypertension. Its presence is a major stake for cirrhotic patients requiring liver transplantation (LT), with increased postoperative mortality and unpredictable evolution after transplantation. The aim was to study outcomes after liver transplantation in patients with portopulmonary hypertension and to identify factors associated with normalization of pulmonary hypertension.

Methods Patients with portopulmonary hypertension who underwent LT between 2008 and 2016 in 8 French centers were retrospectively included. Pulmonary artery pressure was established by right heart catheterization before and after LT. Primary endpoint was the normalization of pulmonary artery pressure after LT.

Results Twenty-three patients who received liver transplant between 2008 and 2016 were included. Two (8.7%) patients died in the immediate posttransplant period from right heart failure. With appropriate vasoactive medical treatment and LT, pulmonary arterial pressure was normalized in 14 patients (60.8%), demonstrating recovery from portopulmonary hypertension. In univariate analysis, the use of vasoactive combination therapy was the only prognostic factor for pulmonary arterial hypertension normalization after LT.

Conclusions Treatment of portopulmonary hypertension with a combination of vasoactive drugs allows LT with acceptable postoperative cardiovascular-related mortality and normalization of pulmonary hypertension in the majority of the patients.

This multicentric French study demonstrates the value of combination vasoactive therapy in liver transplantation for porto-pulmonary hypertension with good results in a well-selected cohort of liver transplantation candidates.

1 Department of Hepatology, Trousseau University Hospital, Tours, France.

2 Department of Hepatobiliary Surgery and Liver Transplantation, Trousseau University Hospital, Tours, France.

3 FHU SUPORT, Tours, France.

4 Department of Hepatology, Hautepierre University Hospital, Strasbourg, France.

5 Department of Hepatology, Herriot University Hospital, Lyon, France.

6 Department of Hepatology, St Eloi University Hospital, Montpellier, France.

7 Department of Hepatology, Purpan University Hospital, Toulouse, France.

8 Department of Hepatology, Huriez University Hospital, Lille, France.

9 Department of Hepatology, Minjoz University Hospital, Besançon, France.

10 Department of Hepatology, Estaing University Hospital, Clermont-Ferrand, France.

11 Department of Pneumology, Bretonneau University Hospital, Tours, France.

12 Echography-Doppler, Bretonneau University Hospital, Tours, France.

13 Service of Public Health, Epidemiology Bretonneau University Hospital, Research Team EE1 EES, Francois Rabelais University, Tours, France.

Received 15 May 2017. Revision received 7 September 2017.

Accepted 3 October 2017.

ARFMAD (Association pour la Recherche et la Formation en Maladies de l’Appareil Digestif) funded the study.

The authors declare no conflicts of interest.

M.R. participated in the research design, writing of the article, and performance of the research, data analysis. L.B. research design, writing of the article, and performance of the research, data analysis. E.S. participated in the performance of the research and correction of the article. C.B. participated in the performance of the research. J.D. participated in the performance of the research. G.-P.P. particpated in the performance of the research. C.B. participated in the performance of the research. S.D. participated in the performance of the research. C.V. participated in the performance of the research. A.A. participated in the performance of the research. M.-L.W.J. participated in the performance of the research. P.M. participated in the performance of the research. F.P. participated in the performance of the research. E.L. participated in data analysis. J.-M.P. participated in the research design, writing of the article, performance of the research, data analysis, and correction of the article.

Correspondence: Maud Reymond, MD, Department of Hepatology, Trousseau University Hospital, Avenue de La République, 37170 Chambray-les-Tours, Fance. (Maud.reymond@hotmail.fr).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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