TY - JOUR
T1 - Survival in portopulmonary hypertension
T2 - Mayo Clinic experience categorized by treatment subgroups
AU - Swanson, K. L.
AU - Wiesner, R. H.
AU - Nyberg, S. L.
AU - Rosen, C. B.
AU - Krowka, M. J.
PY - 2008/11
Y1 - 2008/11
N2 - To determine the natural history of portopulmonary hypertension (POPH), a retrospective screening-right heart catheterization-survival analysis of patients was performed. We categorized patients by three treatment subgroups: (1) no therapy for pulmonary hypertension (PH) or liver transplantation (LT), (2) therapy for PH alone and (3) therapy for PH followed by LT. Seventy-four patients were identified between 1994 and 2007. Nineteen patients received no therapy for PH and no LT representing the natural history of POPH. Five-year survival was 14%, and 54% had died within 1 year of diagnosis. Five-year survival in 43 patients receiving therapy for PH but no LT was 45%, and 12% had died within 1 year of diagnosis. Twelve patients underwent LT and 5-year survival for the nine receiving therapy for PH was 67% versus 25% in the three who were not pretreated with prostacyclin therapy. The survival of untreated patients with POPH was poor. Subgroups of patients selected to medical treatment with or without LT had better long-term survival. Mortality did not correlate with baseline hemodynamic variables, type of liver disease or severity of hepatic dysfunction. Medical therapy for POPH should be considered in all patients with POPH, but the treatment effects and impact on those considered for LT still requires well-designed, prospective study before practice guidelines can be suggested.
AB - To determine the natural history of portopulmonary hypertension (POPH), a retrospective screening-right heart catheterization-survival analysis of patients was performed. We categorized patients by three treatment subgroups: (1) no therapy for pulmonary hypertension (PH) or liver transplantation (LT), (2) therapy for PH alone and (3) therapy for PH followed by LT. Seventy-four patients were identified between 1994 and 2007. Nineteen patients received no therapy for PH and no LT representing the natural history of POPH. Five-year survival was 14%, and 54% had died within 1 year of diagnosis. Five-year survival in 43 patients receiving therapy for PH but no LT was 45%, and 12% had died within 1 year of diagnosis. Twelve patients underwent LT and 5-year survival for the nine receiving therapy for PH was 67% versus 25% in the three who were not pretreated with prostacyclin therapy. The survival of untreated patients with POPH was poor. Subgroups of patients selected to medical treatment with or without LT had better long-term survival. Mortality did not correlate with baseline hemodynamic variables, type of liver disease or severity of hepatic dysfunction. Medical therapy for POPH should be considered in all patients with POPH, but the treatment effects and impact on those considered for LT still requires well-designed, prospective study before practice guidelines can be suggested.
KW - Liver transplantation
KW - Portal hypertension
KW - Pulmonary hypertension
KW - Right heart catheterization
UR - http://www.scopus.com/inward/record.url?scp=53749103602&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=53749103602&partnerID=8YFLogxK
U2 - 10.1111/j.1600-6143.2008.02384.x
DO - 10.1111/j.1600-6143.2008.02384.x
M3 - Article
C2 - 18782292
AN - SCOPUS:53749103602
SN - 1600-6135
VL - 8
SP - 2445
EP - 2453
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 11
ER -