PULMONARY ARTERIAL PRESSURE IN LIVER TRANSPLANT CANDIDATES. A CENTRE EXPERIENCE AND REVIEW OF LITERATURE

  • Irina Iuliana COSTACHE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • O. MITU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Anca Victorita TRIFAN “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • M.S.C. HABA “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • A. PINTILIE “Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania
  • Amalia TIMPAU “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania
  • Adriana ION “Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania
  • R.S. MIFTODE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Ana Maria BUBURUZ “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Irina GIRLEANU “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Abstract

Porto-pulmonary hypertension (POPH), characterized by portal hypertension associated with high pulmonary vascular resistance (PVR), represents an important complication in liver cirrhotic (LC) patients. Our study aimed to determine the association between biological profile and pulmonary hypertension in a group of patients on the liver transplant awaiting list. Material and methods: The current 3-year prospective study analyzed 60 LC patients admitted for liver transplant evaluation and regular follow-up. All patients underwent biochemical evaluation and LC severity was evaluated by using MELD score and Child-Pugh class. Pulmonary hypertension was determined by standardized echocardiographic evaluation, most important markers being mean and systolic pulmonary artery pressure (mPAP, sPAP). Results: Mean age was 50.55 ± 8.3 years, 83.3% males. sPAP was significantly higher in women (24.08±7.76 vs. 27.33±13.7 mmHg, p=0.040). The presence of ascites was directly correlated with the severity of pulmonary hypertension (p=0.033) while mPAP was higher in patients with autoimmune LC. mPAP correlated with MELD score (r=0.832, p=0.030), fibrinogen level (r=0.887, p=0.021) and bilirubin level (r=0.758, p=0.045). During the follow-up period, mPAP decreased significantly in patients that received liver transplant. However, mPAP was not a mortality risk factor for the awaiting liver transplant patients. Conclusions: Our study revealed that fibrinogen and total bilirubin levels, as parameters of cirrhosis severity, are in direct correlation with mPAP. Furthermore, refractory ascites in end-stage cirrhosis patients could be associated with a higher risk of pulmonary hypertension. Further larger studies on POPH incidence and follow-up in liver cirrhosis are warranted.

Author Biographies

Irina Iuliana COSTACHE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania

O. MITU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania

Anca Victorita TRIFAN, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania

M.S.C. HABA, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
 “Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania

Amalia TIMPAU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania

Faculty of Medicine
Department of Medical Specialties (II

R.S. MIFTODE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania

Ana Maria BUBURUZ, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania

Irina GIRLEANU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania

References

1. Chen HS, Xing SR, Xu WG, et al. Portopulmonary hypertension in cirrhotic patients: Prevalence, clinical features, and risk factors. Exp Ther Med 2013; 5: 819-824.
2. Tuder RM, Abman SH, Braun T, et al. Development and pathology of pulmonary hypertension. J Am Coll Cardiol 2009; 54: S3-9.
3. Pham DM, Subramanian R, Parekh S. Coexisting hepatopulmonary syndrome and porto-pulmo-nary hypertension: implications for liver transplantation. J Clin Gastroenterol 2010; 44: e136-40.
4. Colle IO, Moreau R, Godinho E, et al. Diagnosis of portopulmonary hypertension in candidates for liver transplantation: a prospective study. Hepatology 2003; 37: 401-409.
5. Kawut SM, Krowka MJ, Trotter JF, et al. Clinical for risk factors portopulmonary hyperten-sion. Hepatology 2008; 48: 196-203.
6. Porres-Aguilar M, Zuckerman MJ, Figueroa-Casas JB, Krowka MJ. Portopulmonary hypertension: state of the art. Ann Hepatol 2008; 7: 321-330.
7. Kim WR, Krowka MJ, Plevak DJ, et al. Accuracy of Doppler echocardiography in the assessment of pulmonary hypertension in liver transplant candidates. Liver Transpl 2000; 6: 453-458.
8. Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M, et al. Updated clinical classifica-tion of pulmonary hypertension. J Am Coll Cardiol 2009; 54(1 Suppl): S 43-54
9. Bozbas SS, Bozbas H. Portopulmonary hypertension in liver transplant candidates. World J Gastroen-terol. 2016; 22: 2024-2029.
10. Torregrosa M, Genesca J, Gonzalez A, et al. Role of Doppler echocardiography in the assessment of portopulmonary hypertension in liver transplantation candidates. Transplantation 2001; 71: 572-574.
11. Bosch J, García-Pagán JC. Complications of cirrhosis. I. Portal hypertension. J Hepatology 2000; 32: 141-156.
12. Cosarderelioglu C, Cosar AM, Gurakar M, et al. Portopulmonary hypertension and liver transplant: recent review of the literature. Exp Clin Transplant 2016;14: 113-120.
13. Pilatis ND, Jacobs LE, Rerkpattanapipat P, Kotler MN, Owen A, et al. Clinical predictors of pulmonary hypertension in patients undergoing liver transplant evaluation. Liver Transpl 2000; 6: 85-91.
14. Swanson KL, Wiesner RH, Krowka MJ. Natural history of hepatopulmonary syndrome: Impact of liver transplantation. Hepatology 2005; 41: 1122-1129.
15. Austin MJ, McDougall NI, Wendon JA, et al. Safety and efficacy of combined use of sildenafil, bosentan, and iloprost before and after liver transplantation in severe portopulmonary hypertension. Liver Transpl 2008; 14: 287-91.
16. Savale L, Magnier R, Le Pavec J, et al. Efficacy, safety, and pharmacokinetics of Bosentan in por-topulmonary hypertension. Eur Respir J 2013; 41: 96-103.
17. Raevens S, De Pauw M, Reyntjens K, et al. Oral vasodilator therapy in patients with moderate to severe portopulmonary hypertension as a bridge to liver transplantation. Eur J Gastroenterol Hepatol 2013; 25: 495-502.
18. Parasuraman S, Walker S, Loudon B, et al. Assessment of pulmonary artery pressure by echocardiog-raphy-A comprehensive review. Int J Cardiol Heart Vasc 2016; 12: 45-51.
19. Costache II, Miftode E, Mitu O, Aursulesei V. Sex differences in cardiovascular risk factors in a rural community from North Romania region. Revista de Cercetare si Interventie Sociala 2016; 55: 204-214.
20. Costache II, Girleanu I, Mitu O, et al. Correlations between biochemical profile and echocardiographic parameters in patients with cirrhosis of the liver without previous cardiovascular abnormalities. Rev Chim 2018; 69: 2213-2216.
21. Benjaminov FS, Prentice M, Sniderman KW, et al. Portopulmonary hypertension in decompensated cirrhosis with refractory ascites. Gut 2003; 52: 1355-1362.
22. Rodríguez-Roisin R, Krowka MJ, Hervé P, Fallon MB. ERS Task Force Pulmonary-Hepatic Vascular Disorders (PHD) Scientific Committee. Pulmonary-Hepatic Vascular Disorders (PHD). Eur Respir J 2004; 24: 861-880.
Published
2020-12-23
Section
INTERNAL MEDICINE - PEDIATRICS