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...
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| Veröffentlicht in: | Transplant international 2021-06, Vol.34 (6), p.1150-1160 |
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| creator | Lee, Seung‐Ah Hyun, Junho Yoon, Young‐In Park, Seo‐Young Lee, Jae Seung Kim, Dae‐Hee Song, Gi‐Won Kim, Ki‐Hun Moon, Deok‐Bog Song, Jun‐Gol Hwang, Gyu‐Sam Lee, Sung‐Gyu Song, Jong‐Min |
| description | 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. |
| doi_str_mv | 10.1111/tri.13875 |
| format | Article |
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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.</description><identifier>ISSN: 0934-0874</identifier><identifier>EISSN: 1432-2277</identifier><identifier>DOI: 10.1111/tri.13875</identifier><identifier>PMID: 33811394</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adverse events ; Cirrhosis ; Failure ; Graft rejection ; graft survival ; Graft-versus-host reaction ; Grafting ; Grafts ; Hypertension ; Liver ; Liver cirrhosis ; Liver diseases ; Liver transplantation ; Liver transplants ; living donor ; Patients ; prognosis ; Pulmonary arteries ; Pulmonary artery ; Pulmonary hypertension ; Risk ; Sodium ; Surgery ; Survival ; Transplantation</subject><ispartof>Transplant international, 2021-06, Vol.34 (6), p.1150-1160</ispartof><rights>2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd</rights><rights>2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3535-ae0ecf6213a56e4a1cd1874d1c40de326f5517e591904986406e724ed6f3ce5d3</citedby><cites>FETCH-LOGICAL-c3535-ae0ecf6213a56e4a1cd1874d1c40de326f5517e591904986406e724ed6f3ce5d3</cites><orcidid>0000-0002-4093-7928 ; 0000-0002-8209-3540 ; 0000-0002-6754-8199 ; 0000-0002-4016-0995 ; 0000-0001-9161-3491 ; 0000-0002-8275-4871 ; 0000-0002-3627-1107 ; 0000-0002-2702-1536 ; 0000-0002-9308-0366 ; 0000-0002-4235-0434 ; 0000-0002-6076-6978 ; 0000-0003-4211-3081 ; 0000-0003-4130-1486</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Ftri.13875$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftri.13875$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33811394$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Seung‐Ah</creatorcontrib><creatorcontrib>Hyun, Junho</creatorcontrib><creatorcontrib>Yoon, Young‐In</creatorcontrib><creatorcontrib>Park, Seo‐Young</creatorcontrib><creatorcontrib>Lee, Jae Seung</creatorcontrib><creatorcontrib>Kim, Dae‐Hee</creatorcontrib><creatorcontrib>Song, Gi‐Won</creatorcontrib><creatorcontrib>Kim, Ki‐Hun</creatorcontrib><creatorcontrib>Moon, Deok‐Bog</creatorcontrib><creatorcontrib>Song, Jun‐Gol</creatorcontrib><creatorcontrib>Hwang, Gyu‐Sam</creatorcontrib><creatorcontrib>Lee, Sung‐Gyu</creatorcontrib><creatorcontrib>Song, Jong‐Min</creatorcontrib><title>Clinical impact of mild to moderate pulmonary hypertension in living‐donor liver transplantation</title><title>Transplant international</title><addtitle>Transpl Int</addtitle><description>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.</description><subject>Adverse events</subject><subject>Cirrhosis</subject><subject>Failure</subject><subject>Graft rejection</subject><subject>graft survival</subject><subject>Graft-versus-host reaction</subject><subject>Grafting</subject><subject>Grafts</subject><subject>Hypertension</subject><subject>Liver</subject><subject>Liver cirrhosis</subject><subject>Liver diseases</subject><subject>Liver transplantation</subject><subject>Liver transplants</subject><subject>living donor</subject><subject>Patients</subject><subject>prognosis</subject><subject>Pulmonary arteries</subject><subject>Pulmonary artery</subject><subject>Pulmonary hypertension</subject><subject>Risk</subject><subject>Sodium</subject><subject>Surgery</subject><subject>Survival</subject><subject>Transplantation</subject><issn>0934-0874</issn><issn>1432-2277</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp10M1qGzEUBWBRUmon7aIvUATZNItxpJE0P8timsRgCBR3PcjSnUZGI00lTYJ3eYQ8Y56kSpxkUYg2F8HH4XAQ-krJguZ3noJZUNbU4gOaU87Koizr-gjNSct4QZqaz9BxjDtCSNkI8gnNGGsoZS2fo-3SGmeUtNgMo1QJ-x4PxmqcPB68hiAT4HGyg3cy7PHNfoSQwEXjHTYOW3Nr3J_H-wftnQ9PXwg4BeniaKVLMmX3GX3spY3w5eWeoN8XPzfLq2J9fbla_lgXigkmCgkEVF-VlElRAZdUaZqra6o40cDKqheC1iBa2hLeNhUnFdQlB131TIHQ7AR9P-SOwf-dIKZuMFGBzUXAT7ErBWlEXbeMZnr6H935KbjcLisuWk54I7I6OygVfIwB-m4MZsgzdJR0T8N3efjuefhsv70kTtsB9Jt8XTqD8wO4Mxb27yd1m1-rQ-Q_qoiOgQ</recordid><startdate>202106</startdate><enddate>202106</enddate><creator>Lee, Seung‐Ah</creator><creator>Hyun, Junho</creator><creator>Yoon, Young‐In</creator><creator>Park, Seo‐Young</creator><creator>Lee, Jae Seung</creator><creator>Kim, Dae‐Hee</creator><creator>Song, Gi‐Won</creator><creator>Kim, Ki‐Hun</creator><creator>Moon, Deok‐Bog</creator><creator>Song, Jun‐Gol</creator><creator>Hwang, Gyu‐Sam</creator><creator>Lee, Sung‐Gyu</creator><creator>Song, Jong‐Min</creator><general>Blackwell Publishing Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4093-7928</orcidid><orcidid>https://orcid.org/0000-0002-8209-3540</orcidid><orcidid>https://orcid.org/0000-0002-6754-8199</orcidid><orcidid>https://orcid.org/0000-0002-4016-0995</orcidid><orcidid>https://orcid.org/0000-0001-9161-3491</orcidid><orcidid>https://orcid.org/0000-0002-8275-4871</orcidid><orcidid>https://orcid.org/0000-0002-3627-1107</orcidid><orcidid>https://orcid.org/0000-0002-2702-1536</orcidid><orcidid>https://orcid.org/0000-0002-9308-0366</orcidid><orcidid>https://orcid.org/0000-0002-4235-0434</orcidid><orcidid>https://orcid.org/0000-0002-6076-6978</orcidid><orcidid>https://orcid.org/0000-0003-4211-3081</orcidid><orcidid>https://orcid.org/0000-0003-4130-1486</orcidid></search><sort><creationdate>202106</creationdate><title>Clinical impact of mild to moderate pulmonary hypertension in living‐donor liver transplantation</title><author>Lee, Seung‐Ah ; Hyun, Junho ; Yoon, Young‐In ; Park, Seo‐Young ; Lee, Jae Seung ; Kim, Dae‐Hee ; Song, Gi‐Won ; Kim, Ki‐Hun ; Moon, Deok‐Bog ; Song, Jun‐Gol ; Hwang, Gyu‐Sam ; Lee, Sung‐Gyu ; Song, Jong‐Min</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3535-ae0ecf6213a56e4a1cd1874d1c40de326f5517e591904986406e724ed6f3ce5d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adverse events</topic><topic>Cirrhosis</topic><topic>Failure</topic><topic>Graft rejection</topic><topic>graft survival</topic><topic>Graft-versus-host reaction</topic><topic>Grafting</topic><topic>Grafts</topic><topic>Hypertension</topic><topic>Liver</topic><topic>Liver cirrhosis</topic><topic>Liver diseases</topic><topic>Liver transplantation</topic><topic>Liver transplants</topic><topic>living donor</topic><topic>Patients</topic><topic>prognosis</topic><topic>Pulmonary arteries</topic><topic>Pulmonary artery</topic><topic>Pulmonary hypertension</topic><topic>Risk</topic><topic>Sodium</topic><topic>Surgery</topic><topic>Survival</topic><topic>Transplantation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Seung‐Ah</creatorcontrib><creatorcontrib>Hyun, Junho</creatorcontrib><creatorcontrib>Yoon, Young‐In</creatorcontrib><creatorcontrib>Park, Seo‐Young</creatorcontrib><creatorcontrib>Lee, Jae Seung</creatorcontrib><creatorcontrib>Kim, Dae‐Hee</creatorcontrib><creatorcontrib>Song, Gi‐Won</creatorcontrib><creatorcontrib>Kim, Ki‐Hun</creatorcontrib><creatorcontrib>Moon, Deok‐Bog</creatorcontrib><creatorcontrib>Song, Jun‐Gol</creatorcontrib><creatorcontrib>Hwang, Gyu‐Sam</creatorcontrib><creatorcontrib>Lee, Sung‐Gyu</creatorcontrib><creatorcontrib>Song, Jong‐Min</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Transplant international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Seung‐Ah</au><au>Hyun, Junho</au><au>Yoon, Young‐In</au><au>Park, Seo‐Young</au><au>Lee, Jae Seung</au><au>Kim, Dae‐Hee</au><au>Song, Gi‐Won</au><au>Kim, Ki‐Hun</au><au>Moon, Deok‐Bog</au><au>Song, Jun‐Gol</au><au>Hwang, Gyu‐Sam</au><au>Lee, Sung‐Gyu</au><au>Song, Jong‐Min</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical impact of mild to moderate pulmonary hypertension in living‐donor liver transplantation</atitle><jtitle>Transplant international</jtitle><addtitle>Transpl Int</addtitle><date>2021-06</date><risdate>2021</risdate><volume>34</volume><issue>6</issue><spage>1150</spage><epage>1160</epage><pages>1150-1160</pages><issn>0934-0874</issn><eissn>1432-2277</eissn><abstract>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.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>33811394</pmid><doi>10.1111/tri.13875</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-4093-7928</orcidid><orcidid>https://orcid.org/0000-0002-8209-3540</orcidid><orcidid>https://orcid.org/0000-0002-6754-8199</orcidid><orcidid>https://orcid.org/0000-0002-4016-0995</orcidid><orcidid>https://orcid.org/0000-0001-9161-3491</orcidid><orcidid>https://orcid.org/0000-0002-8275-4871</orcidid><orcidid>https://orcid.org/0000-0002-3627-1107</orcidid><orcidid>https://orcid.org/0000-0002-2702-1536</orcidid><orcidid>https://orcid.org/0000-0002-9308-0366</orcidid><orcidid>https://orcid.org/0000-0002-4235-0434</orcidid><orcidid>https://orcid.org/0000-0002-6076-6978</orcidid><orcidid>https://orcid.org/0000-0003-4211-3081</orcidid><orcidid>https://orcid.org/0000-0003-4130-1486</orcidid></addata></record> |
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| source | Wiley Online Library Journals Frontfile Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Adverse events Cirrhosis Failure Graft rejection graft survival Graft-versus-host reaction Grafting Grafts Hypertension Liver Liver cirrhosis Liver diseases Liver transplantation Liver transplants living donor Patients prognosis Pulmonary arteries Pulmonary artery Pulmonary hypertension Risk Sodium Surgery Survival Transplantation |
| title | Clinical impact of mild to moderate pulmonary hypertension in living‐donor liver transplantation |
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