Portopulmonary hypertension and the liver transplant candidate
The management of the liver transplant (OLT) candidate with portopulmonary hypertension (PPHTN) has dramatically changed in the past 3 years. Careful preoperative evaluation with functional characterization of right ventricular function plays a critical role. The pulmonary vascular response to epoprostenol infusion serves as a deciding factor for OLT candidacy. Careful perioperative attention to avoid right ventricular failure from acutely elevated pulmonary artery pressures or sudden increases in right ventricular preload is a key physiologic tenet of management. With increased surgical expertise, anesthetic sophistication, and availability of epoprostenol, PPHTN is no longer considered an absolute contraindication for OLT.
Kuo, P., Plotkin, J., Gaine, S., Schroeder, R., Rustgi, V., Rubin, L., & Johnson, L. (1999). Portopulmonary hypertension and the liver transplant candidate. Transplantation, 67 (8). http://dx.doi.org/10.1097/00007890-199904270-00001