Pulmonary Arterial Pressure In Liver Transplant Candidates. A Centre Experience And Review Of Literature

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.