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. 2014 Aug;59(8):1976-82.
doi: 10.1007/s10620-014-3065-y. Epub 2014 Feb 21.

Outcomes of liver transplantation for porto-pulmonary hypertension in model for end-stage liver disease era

Reena J Salgia  1 , Nathan P Goodrich, Heather Simpson, Robert M Merion, Pratima Sharma
Affiliations

Outcomes of liver transplantation for porto-pulmonary hypertension in model for end-stage liver disease era

Reena J Salgia et al. Dig Dis Sci. 2014 Aug.

Abstract

Porto-pulmonary hypertension (POPH), once considered an absolute contraindication for liver transplantation (LT), has become a more accepted indication because of the evolution of treatment with prostacyclin analogues, phosphodiesterase inhibitors and endothelin receptor antagonists. An exception model for end stage liver disease (MELD) score of 22 is assigned to candidates with documentation of effective treatment. We examined the post-transplant outcomes of patients who received LT for POPH with exception.

Methods: Scientific Registry of Transplant Recipients data on 34,318 adult (≥ 18 years) deceased donor LT recipients transplanted between March 1, 2002 and August 31, 2010 were reviewed. The diagnosis of POPH was ascertained from MELD exception forms. Patients were followed from the time of transplant until the earlier occurrence of death or end of the follow-up period. Cox regression was used to evaluate the predictors of post-LT mortality and graft failure.

Results: During the study period, 34,318 patients received deceased donor LT. Seventy eight out of 34,318 patients were transplanted for POPH with MELD exception. The 1-year adjusted risks of patient death and graft failure for patients transplanted under exception rules for POPH were significantly higher than with POPH adult recipients who did not receive exception points (death:hazard ratio [HR] = 2.25, p = 0.005 and graft failure HR = 1.96, p = 0.012).

Conclusions: This study of national data suggests that treated POPH continues to be associated with inferior early post-transplant outcomes.

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Figures

Figure 1
Figure 1
Description of Cohort Abbreviations: LT= Liver Transplantation; POPH=Portopulmonary hypertension
Figure 2A
Figure 2A
Adjusted overall patient survival comparing LT recipients with portopulmonary hypertension (POPH) versus without POPH.
Figure 2B
Figure 2B
Adjusted graft survival stratified by portopulmonary hypertension (POPH) versus without POPH LT recipients
See this image and copyright information in PMC

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