| Acute and long-term effects of inhaled iloprost in portopulmonary hypertension. | |
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MedLine Citation:
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PMID: 20209595 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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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:
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Created Date: 2010-03-15 Completed Date: 2010-07-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100909185 Medline TA: Liver Transpl Country: United States |
Other Details:
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Languages: eng Pagination: 348-56 Citation Subset: IM |
Affiliation:
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Department of Pulmonary Medicine, University of Barcelona, Barcelona, Spain. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Vasodilator Agents; 78919-13-8/Iloprost |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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