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  • Title: Liver transplantation in patients with severe portopulmonary hypertension treated with preoperative chronic intravenous epoprostenol.
    Author: Tan HP, Markowitz JS, Montgomery RA, Merritt WT, Klein AS, Thuluvath PJ, Poordad FF, Maley WR, Winters B, Akinci SB, Gaine SP.
    Journal: Liver Transpl; 2001 Aug; 7(8):745-9. PubMed ID: 11510023.
    Abstract:
    Portopulmonary hypertension (PPHTN) is no longer an absolute contraindication to orthotopic liver transplantation (OLT). The pre-OLT management of patients with PPHTN requires early diagnosis and chronic therapy with intravenous epoprostenol to decrease pulmonary vascular resistance (PVR). Close follow-up is necessary to reassess pulmonary artery pressures (PAPs) and evaluate right ventricular (RV) function. This assists in the optimal timing of OLT. Successful management also necessitates reassessment of pulmonary artery hemodynamics just before OLT, with clearly defined parameters used to determine whether to proceed. Even with the intraoperative and postoperative availability of potent pulmonary vasodilators, clinical management may be suboptimal in reducing PAP. Adequate reduction in PVR and improvement in RV function in response to chronic epoprostenol therapy may facilitate successful OLT. We present a case report and review the limited experience with this treatment.
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