Frequency and clinical implications of increased pulmonary artery pressures in liver transplant patients

M. Castro, Michael Joseph Krowka, D. R. Schroeder, K. C. Beck, D. J. Plevak, S. R. Rettke, D. A. Cortese, R. H. Wiesner

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Abstract

Objective: To characterize the pulmonary hemodynamics and identify predictors of pulmonary hypertension in a group of patients before liver transplantation and to determine whether pulmonary hypertension in these patients is related to survival. Material and Methods: In 362 patients before their first liver transplantation (between 1985 and 1993), the clinical history, laboratory data, and results of pulmonary function tests were recorded. Pulmonary artery (PA) catheterization was performed after induction of anesthesia at the time of transplantation. Monthly follow-up was maintained. Results: A hyperdynamic circulation was often present-an increased mean cardiac output (7.6 L/min), increased mean PA pressure (20.9 mm Hg), correlation of mean PA pressure with cardiac output (r = 0.25; P<0.001), and decreased mean pulmonary vascular resistance (60 dynes · s/cm5). Mean PA pressures were more than 25 mm Hg in 72 patients (20%). Pulmonary hypertension (defined as mean PA pressure of more than 25 mm Hg and pulmonary vascular resistance in excess of 120 dynes · s/cm5) occurred in 15 patients (4%). Pulmonary function tests revealed obstruction in 7%, restriction in 18%, and low diffusing capacity in 46%. By univariate analysis, lower forced expiratory volume in 1 second, forced vital capacity, and total lung capacity were the only preoperative factors associated with pulmonary hypertension (P<0.05). Survival was significantly lower in patients with acute fulminant hepatitis (P<0.001), the group with the highest mean PA pressure, than in those with other diagnoses. Increased PA pressures or mild to moderate pulmonary hypertension was not found to be associated with a worse survival by univariate or multivariate analysis. Conclusion: Increased PA pressure is common in liver transplant patients (20%). 'True' pulmonary hypertension occurred in only 4% of our patients and was not associated with an adverse outcome.

Original languageEnglish (US)
Pages (from-to)543-551
Number of pages9
JournalMayo Clinic Proceedings
Volume71
Issue number6
StatePublished - 1996

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Pulmonary Artery
Pulmonary Hypertension
Transplants
Pressure
Liver
Respiratory Function Tests
Cardiac Output
Vascular Resistance
Liver Transplantation
Swan-Ganz Catheterization
Total Lung Capacity
Survival
Vital Capacity
Forced Expiratory Volume
Survival Analysis
Hepatitis
Multivariate Analysis
Anesthesia
Transplantation
Hemodynamics

ASJC Scopus subject areas

  • Medicine(all)

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Castro, M., Krowka, M. J., Schroeder, D. R., Beck, K. C., Plevak, D. J., Rettke, S. R., ... Wiesner, R. H. (1996). Frequency and clinical implications of increased pulmonary artery pressures in liver transplant patients. Mayo Clinic Proceedings, 71(6), 543-551.

Frequency and clinical implications of increased pulmonary artery pressures in liver transplant patients. / Castro, M.; Krowka, Michael Joseph; Schroeder, D. R.; Beck, K. C.; Plevak, D. J.; Rettke, S. R.; Cortese, D. A.; Wiesner, R. H.

In: Mayo Clinic Proceedings, Vol. 71, No. 6, 1996, p. 543-551.

Research output: Contribution to journalArticle

Castro, M, Krowka, MJ, Schroeder, DR, Beck, KC, Plevak, DJ, Rettke, SR, Cortese, DA & Wiesner, RH 1996, 'Frequency and clinical implications of increased pulmonary artery pressures in liver transplant patients', Mayo Clinic Proceedings, vol. 71, no. 6, pp. 543-551.
Castro, M. ; Krowka, Michael Joseph ; Schroeder, D. R. ; Beck, K. C. ; Plevak, D. J. ; Rettke, S. R. ; Cortese, D. A. ; Wiesner, R. H. / Frequency and clinical implications of increased pulmonary artery pressures in liver transplant patients. In: Mayo Clinic Proceedings. 1996 ; Vol. 71, No. 6. pp. 543-551.
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abstract = "Objective: To characterize the pulmonary hemodynamics and identify predictors of pulmonary hypertension in a group of patients before liver transplantation and to determine whether pulmonary hypertension in these patients is related to survival. Material and Methods: In 362 patients before their first liver transplantation (between 1985 and 1993), the clinical history, laboratory data, and results of pulmonary function tests were recorded. Pulmonary artery (PA) catheterization was performed after induction of anesthesia at the time of transplantation. Monthly follow-up was maintained. Results: A hyperdynamic circulation was often present-an increased mean cardiac output (7.6 L/min), increased mean PA pressure (20.9 mm Hg), correlation of mean PA pressure with cardiac output (r = 0.25; P<0.001), and decreased mean pulmonary vascular resistance (60 dynes · s/cm5). Mean PA pressures were more than 25 mm Hg in 72 patients (20{\%}). Pulmonary hypertension (defined as mean PA pressure of more than 25 mm Hg and pulmonary vascular resistance in excess of 120 dynes · s/cm5) occurred in 15 patients (4{\%}). Pulmonary function tests revealed obstruction in 7{\%}, restriction in 18{\%}, and low diffusing capacity in 46{\%}. By univariate analysis, lower forced expiratory volume in 1 second, forced vital capacity, and total lung capacity were the only preoperative factors associated with pulmonary hypertension (P<0.05). Survival was significantly lower in patients with acute fulminant hepatitis (P<0.001), the group with the highest mean PA pressure, than in those with other diagnoses. Increased PA pressures or mild to moderate pulmonary hypertension was not found to be associated with a worse survival by univariate or multivariate analysis. Conclusion: Increased PA pressure is common in liver transplant patients (20{\%}). 'True' pulmonary hypertension occurred in only 4{\%} of our patients and was not associated with an adverse outcome.",
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AU - Castro, M.

AU - Krowka, Michael Joseph

AU - Schroeder, D. R.

AU - Beck, K. C.

AU - Plevak, D. J.

AU - Rettke, S. R.

AU - Cortese, D. A.

AU - Wiesner, R. H.

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N2 - Objective: To characterize the pulmonary hemodynamics and identify predictors of pulmonary hypertension in a group of patients before liver transplantation and to determine whether pulmonary hypertension in these patients is related to survival. Material and Methods: In 362 patients before their first liver transplantation (between 1985 and 1993), the clinical history, laboratory data, and results of pulmonary function tests were recorded. Pulmonary artery (PA) catheterization was performed after induction of anesthesia at the time of transplantation. Monthly follow-up was maintained. Results: A hyperdynamic circulation was often present-an increased mean cardiac output (7.6 L/min), increased mean PA pressure (20.9 mm Hg), correlation of mean PA pressure with cardiac output (r = 0.25; P<0.001), and decreased mean pulmonary vascular resistance (60 dynes · s/cm5). Mean PA pressures were more than 25 mm Hg in 72 patients (20%). Pulmonary hypertension (defined as mean PA pressure of more than 25 mm Hg and pulmonary vascular resistance in excess of 120 dynes · s/cm5) occurred in 15 patients (4%). Pulmonary function tests revealed obstruction in 7%, restriction in 18%, and low diffusing capacity in 46%. By univariate analysis, lower forced expiratory volume in 1 second, forced vital capacity, and total lung capacity were the only preoperative factors associated with pulmonary hypertension (P<0.05). Survival was significantly lower in patients with acute fulminant hepatitis (P<0.001), the group with the highest mean PA pressure, than in those with other diagnoses. Increased PA pressures or mild to moderate pulmonary hypertension was not found to be associated with a worse survival by univariate or multivariate analysis. Conclusion: Increased PA pressure is common in liver transplant patients (20%). 'True' pulmonary hypertension occurred in only 4% of our patients and was not associated with an adverse outcome.

AB - Objective: To characterize the pulmonary hemodynamics and identify predictors of pulmonary hypertension in a group of patients before liver transplantation and to determine whether pulmonary hypertension in these patients is related to survival. Material and Methods: In 362 patients before their first liver transplantation (between 1985 and 1993), the clinical history, laboratory data, and results of pulmonary function tests were recorded. Pulmonary artery (PA) catheterization was performed after induction of anesthesia at the time of transplantation. Monthly follow-up was maintained. Results: A hyperdynamic circulation was often present-an increased mean cardiac output (7.6 L/min), increased mean PA pressure (20.9 mm Hg), correlation of mean PA pressure with cardiac output (r = 0.25; P<0.001), and decreased mean pulmonary vascular resistance (60 dynes · s/cm5). Mean PA pressures were more than 25 mm Hg in 72 patients (20%). Pulmonary hypertension (defined as mean PA pressure of more than 25 mm Hg and pulmonary vascular resistance in excess of 120 dynes · s/cm5) occurred in 15 patients (4%). Pulmonary function tests revealed obstruction in 7%, restriction in 18%, and low diffusing capacity in 46%. By univariate analysis, lower forced expiratory volume in 1 second, forced vital capacity, and total lung capacity were the only preoperative factors associated with pulmonary hypertension (P<0.05). Survival was significantly lower in patients with acute fulminant hepatitis (P<0.001), the group with the highest mean PA pressure, than in those with other diagnoses. Increased PA pressures or mild to moderate pulmonary hypertension was not found to be associated with a worse survival by univariate or multivariate analysis. Conclusion: Increased PA pressure is common in liver transplant patients (20%). 'True' pulmonary hypertension occurred in only 4% of our patients and was not associated with an adverse outcome.

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