Clinical impact of mild to moderate pulmonary hypertension in living‐donor liver transplantation

Summary Severe pulmonary hypertension (PHT) is a contraindication to liver transplantation (LT); however, the prognostic implication of mild to moderate PHT in living‐donor LT (LDLT) is unknown. The study cohort retrospectively included 1307 patients with liver cirrhosis who underwent LDLT. PHT was defined as a mean pulmonary artery pressure (PAP) of ≥25 mmHg, measured intraoperatively just before surgery. The primary endpoint was graft failure within 1 year after LDLT, including retransplantation or death from any cause. The secondary endpoints were in‐hospital adverse events. In the overall cohort, the median Model for End‐stage Liver Disease‐Sodium (MELD‐Na) score was 19, and 100 patients (7.7%) showed PHT. During 1‐year follow‐up, graft failure occurred in 94 patients (7.2%). Patients with PHT had lower 1‐year graft survival (86% vs. 93.4%, P = 0.005) and survival rates (87% vs. 93.6%, P = 0.011). Mean PAP was associated with a high risk of in‐hospital adverse events and 1‐year graft failure. Adding the mean PAP to the clinical risk model improved the risk prediction. In conclusion, mild to moderate PHT was associated with higher risks of 1‐year graft failure and in‐hospital events, including mortality after LDLT in patients with liver cirrhosis. Intraoperative mean PAP can help predict the early clinical outcomes after LDLT.