Excellent Post-transplant Survival Research Articles

The Impact of Treatment of Portopulmonary Hypertension on Survival Following Liver Transplantation

Pulmonary hypertension in the setting of cirrhosis and portal hypertension is known as portopulmonary hypertension (PPHTN). Moderate or severe PPHTN is uncommon, but has a poor prognosis and is considered to be a contraindication to liver transplantation. We assessed the impact of vasodilation therapy on pulmonary hemodynamics and outcome after liver transplant in these patients. Eighty-six patients evaluated for liver transplant between 1997 and 2005 had an estimated right ventricular systolic pressure >40 mm Hg or a clinical suspicion of PPHTN. Right heart catheterization confirmed PPHTN in 30 patients (ten mild, eight moderate, and 12 severe). Sixteen of the 20 with moderate-to-severe pulmonary hypertension (mPAP >or= 35) were otherwise considered suitable liver transplant candidates and were treated with vasodilation therapy. mPAP fell to less than 35 mm Hg in 12 patients (75%) and 11 of them then underwent orthotopic liver transplantation. One- and five-year survivals in the transplanted patients were 91% and 67%, respectively. Nine of 11 were off vasodilator therapy after a median of 9.2 months following transplantation. None of the patients who failed vasodilator therapy survived (median survival, 8 months). Effective pharmacologic control of PPHTN before liver transplant is associated with excellent posttransplant survival that is similar to patients transplanted for other indications.

OSTEOPOROSIS

Osteopenia, in the form of osteoporosis, is a common complication of chronic cholestatic liver diseases and, although its cause is poorly understood, it appears to be intimately related to the cholestasis itself. With more patients surviving longer with successful liver transplantation, the clinical significance of such osteopenia has increased, and a traumatic fracturing has become a major cause of morbidity in this patient population. Noninvasive diagnosis is easy, and serial measurements allow assessment of disease progression. Although no effective therapy can treat or prevent this complication, supportive measures can improve skeletal well-being, especially in high-risk individuals who are candidates for liver transplantation.