Document Detail

Volume-mediated pulmonary responses in liver transplant candidates.
MedLine Citation:
PMID:  8996773     Owner:  NLM     Status:  MEDLINE    
Pulmonary hypertension, defined as mean pulmonary artery pressure (mPAP) greater than or equal to 25 mmHg, is a recognized complication of hepatic dysfunction with portal hypertension and is considered a relative contraindication to liver transplantation. To characterize pulmonary hemodynamic responses in OLT candidates without pre-existing primary pulmonary hypertension, 22 consecutive patients referred for OLT at the Stanford University Hospital underwent prospective right heart catheterization with pressure determinations at baseline and following infusion of 11 crystalloid over 10 min. In addition, EKG, chest X-ray and transthoracic echocardiograms were performed as a part of the routine evaluation. Eleven non-cirrhotic patients served as controls. At baseline, 1/22 (4.5%) OLT patients had pulmonary hypertension while 9/22 (41%) developed pulmonary hypertension following volume infusion (p < 0.0001). In contrast, 0/11 controls manifested elevated pulmonary pressures at baseline or following volume challenge. OLT candidates were found to have significant increases in mean pulmonary pressure and capillary wedge pressure (PCWP) compared to controls, suggesting intravascular volume overload or left ventricular dysfunction as potential causes. OLT candidates who manifested volume-dependent pulmonary hypertension (a) had a 2-fold higher baseline PCWP, (b) currently smoked, and (c) had previously undergone portosystemic shunts. Aggregate analysis of EKG, echo and CXR for determination of volume-mediated pulmonary hypertension revealed a sensitivity of 25%, specificity of 75% and a positive predictive value of 40%. Preoperative identification of patients with a predisposition to manifesting elevated pulmonary pressures in the context of rapid volume infusion offers the potential for improved risk stratification and optimized clinical management.
P C Kuo; R A Schroeder; R H Vagelos; H Valantine; G Garcia; E J Alfrey; G Haddow; D C Dafoe
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Clinical transplantation     Volume:  10     ISSN:  0902-0063     ISO Abbreviation:  Clin Transplant     Publication Date:  1996 Dec 
Date Detail:
Created Date:  1997-04-03     Completed Date:  1997-04-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8710240     Medline TA:  Clin Transplant     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  521-7     Citation Subset:  IM    
Department of Surgery, Stanford University Medical Center, USA.
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MeSH Terms
Blood Pressure
Blood Volume
Heart Catheterization
Hypertension, Portal / etiology
Hypertension, Pulmonary / diagnosis,  etiology
Infusions, Intravenous
Isotonic Solutions
Liver Cirrhosis / complications,  physiopathology
Liver Diseases / complications
Liver Transplantation / contraindications,  physiology*
Middle Aged
Plasma Substitutes / administration & dosage,  diagnostic use
Portasystemic Shunt, Surgical / adverse effects
Predictive Value of Tests
Prospective Studies
Pulmonary Artery / physiology*
Pulmonary Wedge Pressure
Radiography, Thoracic
Rehydration Solutions / administration & dosage,  diagnostic use
Risk Assessment
Sensitivity and Specificity
Smoking / adverse effects
Ventricular Dysfunction, Left / complications
Reg. No./Substance:
0/Isotonic Solutions; 0/Plasma Substitutes; 0/Rehydration Solutions; 0/crystalloid solutions

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