Document Detail


Acute and long-term effects of inhaled iloprost in portopulmonary hypertension.
MedLine Citation:
PMID:  20209595     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Portopulmonary hypertension (PoPH) is a serious condition without an established treatment. Drugs used to treat pulmonary hypertension may have detrimental effects on portal hypertension. This study was designed to assess in patients with PoPH the acute effects of inhaled iloprost (iILO) on pulmonary and hepatic hemodynamics and to evaluate the clinical outcome after 12 months of treatment. We conducted 2 separate studies. In the first one, 21 patients with PoPH were acutely tested with 2.8 microg of iILO. Pulmonary and hepatic hemodynamics were assessed at the baseline and through 60 minutes after iILO. In the second one, we retrospectively evaluated 12 patients treated with iILO (30 microg/day) for more than 1 year. The 6-minute walk distance (6MWD), functional class (FC), and echocardiogram were analyzed at the baseline and after 12 months of treatment. In the acute study, iILO rapidly reduced pulmonary artery pressure (PAP; -16% + or - 8%, P < 0.001) and pulmonary vascular resistance (-18% + or - 14%, P < 0.001). The cardiac output did not change initially but decreased after 30 minutes. The hepatic venous pressure gradient (HVPG) and hepatic blood flow did not vary through the study. Pulmonary vasodilation induced by iILO was inversely related to HVPG. In the long-term evaluation, iILO improved FC by 1 or more in 7 patients (P = 0.04) and increased 6MWD by 67 + or - 59 m at 12 months (P < 0.001). No change in systolic PAP was observed. Two patients died because of hepatic complications, and 4 additional patients presented clinically significant events that were related to hepatic disease in 2 and worsening of pulmonary hypertension in 2. We conclude that in patients with PoPH, iILO produces rapid and selective pulmonary vasodilation without altering the hepatic hemodynamics. Its long-term use may provide sustained improvements in symptoms and exercise tolerance in some patients with PoPH. A randomized, controlled trial is warranted to establish its clinical role in this serious condition.
Authors:
Maria Teresa Melgosa; Giovanni L Ricci; Juan Carlos García-Pagan; Isabel Blanco; Pilar Escribano; Juan G Abraldes; Josep Roca; Jaume Bosch; Joan Albert Barberà
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  16     ISSN:  1527-6473     ISO Abbreviation:  Liver Transpl.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-15     Completed Date:  2010-07-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  United States    
Other Details:
Languages:  eng     Pagination:  348-56     Citation Subset:  IM    
Affiliation:
Department of Pulmonary Medicine, University of Barcelona, Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Adult
Blood Pressure / drug effects,  physiology
Cohort Studies
Dose-Response Relationship, Drug
Female
Humans
Hypertension, Portal / drug therapy*,  physiopathology
Hypertension, Pulmonary / drug therapy*,  physiopathology
Iloprost / administration & dosage,  pharmacology,  therapeutic use*
Liver Circulation / drug effects,  physiology
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Vascular Resistance / drug effects,  physiology
Vasodilator Agents / administration & dosage,  pharmacology,  therapeutic use*
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 78919-13-8/Iloprost

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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