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. 2022 Oct 7;8(11):e1372.
doi: 10.1097/TXD.0000000000001372. eCollection 2022 Nov.

Liver Transplant Outcomes in Patients With Postcapillary Pulmonary Hypertension

Cerise Kleb  1 , Manik Aggarwal  2 , Adriano R Tonelli  3 , Mattie White  1 , Ruishen Lyu  4 , Cristiano Quintini  5 , Koji Hashimoto  5 , Charles Miller  5 , Jacek Cywinski  6 , Bijan Eghtesad  5 , Maan Fares  7 , K V Narayanan Menon  8
Affiliations

Liver Transplant Outcomes in Patients With Postcapillary Pulmonary Hypertension

Cerise Kleb et al. Transplant Direct. .

Abstract

Postcapillary pulmonary hypertension (PH) can be seen in cirrhosis. Research and treatment goals exist for patients with portopulmonary hypertension but not for postcapillary PH. The aim of this study was to investigate outcomes after liver transplant (LT) for patients with postcapillary PH.

Methods: This was a retrospective cohort study of 1173 patients who underwent LT at our center between 2010 and 2020. Using a propensity score matched analysis followed by multivariable Cox modeling on matched patients, we compared post-LT survival between patients with and without postcapillary PH. We also compared several post-LT outcomes between patient with different types of PH.

Results: Sixty-eight patients had PH, and 50 had postcapillary PH. The median age was 59 y and the sample was 54% male. There was no significant difference in mortality between patients with postcapillary PH and patients without PH (hazard ratio, 1.72; 95% confidence interval, 0.90-3.31; P = 0.10). There was no significant difference in survival between patients with any type of PH and those without PH. There was no significance difference in post-LT survival, acute kidney injury, or pulmonary edema between patients with different types of PH. Patients with postcapillary PH who survived had a higher cardiac output than those who died (11 L/min in patients who lived, as compared with 8 L/min in patients who died; P = 0.03).

Conclusions: Postcapillary PH does not appear to convey a negative impact on post-LT survival. A higher cardiac output may be protective against mortality in patients with postcapillary PH.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Kaplan-Meier survival: postcapillary PH vs no PH. Kaplan-Meier curve comparing survival of patients with postcapillary PH to matched patients with no PH. The 1-, 3-, and 5-y survival in the postcapillary PH group was 78.0%, 76.0%, and 70.7%, respectively. The 1-, 3-, and 5-y survival in the non-PH group was 89.4%, 84.7%, and 79.0%, respectively. PH, pulmonary hypertension.
FIGURE 2.
FIGURE 2.
Kaplan-Meier survival: PH vs no PH. Kaplan-Meier curve comparing survival of patients with any type of PH to matched patients without PH. Survival at 1, 3, and 5 y was 89.4%, 84.7%, and 79.0%, respectively, in the group of patients without PH, and 83.8%, 82.3%, and 76.1%, respectively, in the group of patients with PH. PH, pulmonary hypertension.
FIGURE 3.
FIGURE 3.
Kaplan-Meier curve: postcapillary PH vs POPH vs PH because of high CO. Kaplan-Meier curve comparing survival of patients with different types of PH. The 1-, 3-, and 5-y survival was 78.0%, 76.0%, and 70.7%, respectively, in the postcapillary PH group. Survival at 1, 3, and 5 y was 100% in the POPH group. CO, cardiac output; PH, pulmonary hypertension; POPH, portopulmonary hypertension.
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