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Does the Severity of Portopulmonary Hypertension (POPH) Matter in the Intensive Care Unit (ICU) Post Liver Transplant?

Gallo Moraes

Michael Krowka

Rodrigo Cartin-Ceba


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Conference: 2014 International PHA Conference and Scientific Sessions

Release Date: 06.21.2014

Presentation Type: Abstracts

File Download: 2014 Conference Abstract - Alice Gallo de Morales

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Introduction: Moderate to severe POPH has been associated with adverse liver transplant (LT) outcomes. To date, sparse data are available regarding the immediate postoperative period. It is unclear whether the degree of POPH affects weaning from mechanical ventilation or length of stay (LOS) in the ICU after LT.

Patients and Methods: All patients diagnosed with POPH from January/2002 to November/2013 who underwent LT at our institution were included. The diagnosis was based on standard right heart catheterization (RHC) criteria. POPH was classified as severe and not-severe, according to measured mean pulmonary arterial pressure (MPAP): equal and greater than 45mmHg or below 45, respectively. Baseline data included etiology of liver dysfunction, MELD score, pulmonary hemodynamic data obtained during RHC, use of pulmonary arterial targeted therapy prior and after LT, LOS in the ICU after transplantation,  number of days on mechanical ventilation and vasopressors requirements.

Results: A total of 14 patients were identified (10 women).  Median age at POPH diagnosis was 50 years (range: 12-64 years). Alcoholic cirrhosis was the most common cause of portal hypertension (4 patients, 28.5%). Six (43%) patients had severe POPH.  MELD score was not found to correlate with the degree of POPH. Median LOS in the ICU for patient with severe POPH was 3 days (range 1-25 days) compared to 2 days for non-severe POPH (range 0-21 days, p=0.2). Median days on mechanical ventilation were the same on both groups, 1 day. Ranging from 0-4 days in the severe POPH group and 0-21 days in the non-severe (p=0.59). All patients were transferred to the ICU on low dose pressors, following LT. The most frequently used was norepinephrine. Only 16% of the patients with severe POPH required two or more pressors, compared to 83% in the non-severe POPH group. All but one patient, were on pulmonary arterial targeted therapy at the time of ICU admission; prostacyclin was the most commonly used (8 patients, 58%), followed by ambrisentan (3 patients, 21%). Only 2 patients (one with severe POPH) required addition of pulmonary arterial targeted therapy during ICU stay. Weaning from pulmonary arterial targeted therapy did not occur while in the ICU.

Conclusion: We failed to show differences regarding LOS and ventilated days in the ICU following LT in patients with severe or non-severe POPH. Requirements for low dose vasopressors were also similar in both groups. Patients were not weaned from pulmonary arterial targeted therapies during their ICU stay. ICU outcomes were not related to severity of POPH.

Type: Clinical Science