Ramsay et al. Liver Transplantation and Surgery, Vol 3 No 5 (Sept), 1997: 494-500.

Reviewed by: R. Prasad, MD

Comments:

• Large series of patients, althouth only 12 with severe PHTN.
• Using mean PAP would be better than systolic PAP - less subject to artifact.

• Reviewed 1205 consecutive OLTs at Baylor, 12/84-10/95.
• PHTN defined as mean PAP >=25, and PVR>120)
• PHTN incidence 8.5%: 81 mild, 14 moderate, 7 severe (+5 others with severe PHTN who died during evaluation or not candidates).
• 12 severe = 9 primary PHTN + 3 mixed pathology (PPHTN, hepatorenal syndrome with volume overload, secondary cardiac dysfnct).
• Despite initially doing well after OLT, PHTN did not resolve in most with severe PHTN.

Their recommendations:

• Reversible P HTN = positive response (20-30% dec in PVR and mean PAP) to vasodilator (PGE1 often used; also, nifedipine, NO occasionally).
• Suggests improved survival, with decreased PAP after OLT.
• Irreversible PHTN suggests low likelighood that OLT will reverse PHTN.
• PPHTN-associated-mortality may best correllate with RV fnct, as well as mean PAP. Good RV fnct + moderate PHTN = good chance of survival.
• Monitor OLT candidates with q3mo echo.
• Cancel OLT if mean PAP>45 that is not reversible with pulm vasodilators.