A subclinical high tricuspid regurgitation pressure gradient independent of the mean pulmonary artery pressure is a risk factor for the survival after living donor liver transplantation

Yosuke Saragai, Akinobu Takaki, Yuzo Umeda, Takashi Matsusaki, Tetsuya Yasunaka, Atsushi Oyama, Ryuji Kaku, Kazufumi Nakamura, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Kosei Takagi, Takuya Adachi, Nozomu Wada, Yasuto Takeuchi, Kazuko Koike, Fusao Ikeda, Hideki Ohnishi, Hidenori Shiraha, Shinichiro NakamuraHiroshi Morimatsu, Hiroshi Itoh, Toshiyoshi Fujiwara, Takahito Yagi, Hiroyuki Okada

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Abstract

Background: Portopulmonary hypertension (POPH) is characterized by pulmonary vasoconstriction, while hepatopulmonary syndrome (HPS) is characterized by vasodilation. Definite POPH is a risk factor for the survival after orthotopic liver transplantation (OLT), as the congestive pressure affects the grafted liver, while subclinical pulmonary hypertension (PH) has been acknowledged as a non-risk factor for deceased donor OLT. Given that PH measurement requires cardiac catheterization, the tricuspid regurgitation pressure gradient (TRPG) measured by echocardiography is used to screen for PH and congestive pressure to the liver. We investigated the impact of a subclinical high TRPG on the survival of small grafted living donor liver transplantation (LDLT). Methods: We retrospectively analyzed 84 LDLT candidates. Patients exhibiting a TRPG ≥25 mmHg on echocardiography were categorized as potentially having liver congestion (subclinical high TRPG; n=34). The mean pulmonary artery pressure (mPAP) measured after general anesthesia with FIO20.6 (mPAP-FIO20.6) was also assessed. Patients exhibiting pO2<80 mmHg and an alveolar-arterial oxygen gradient (AaDO2)≥15 mmHg were categorized as potentially having HPS (subclinical HPS; n=29). The clinical course after LDLT was investigated according to subclinical high TRPG. Results: A subclinical high TRPG (p=0.012) and older donor age (p=0.008) were correlated with a poor 40-month survival. Although a higher mPAP-FIO20.6 was expected to correlate with a worse survival, a high mPAP-FIO20.6 with a low TRPG was associated with high frequency complicating subclinical HPS and a good survival, suggesting a reduction in the PH pressure via pulmonary shunt. Conclusion: In cirrhosis patients, mPAP-FIO20.6 may not accurately reflect the congestive pressure to the liver, as the pressure might escape via pulmonary shunt. A subclinical high TRPG is an important marker for predicting a worse survival after LDLT, possibly reflecting congestive pressure to the grafted small liver.

Original languageEnglish
Article number62
JournalBMC Gastroenterology
Volume18
Issue number1
DOIs
Publication statusPublished - May 15 2018

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Tricuspid Valve Insufficiency
Living Donors
Liver Transplantation
Pulmonary Artery
Pressure
Survival
Hepatopulmonary Syndrome
Pulmonary Hypertension
Liver
Lung
Echocardiography
Tissue Donors
Hypertension

Keywords

  • Hepatopulmonary syndrome
  • Living donor related liver transplantation
  • Portopulmonary hypertension
  • Tricuspid regurgitation pressure gradient

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{51108a10608542cf8bbec0b0074bb03e,
title = "A subclinical high tricuspid regurgitation pressure gradient independent of the mean pulmonary artery pressure is a risk factor for the survival after living donor liver transplantation",
abstract = "Background: Portopulmonary hypertension (POPH) is characterized by pulmonary vasoconstriction, while hepatopulmonary syndrome (HPS) is characterized by vasodilation. Definite POPH is a risk factor for the survival after orthotopic liver transplantation (OLT), as the congestive pressure affects the grafted liver, while subclinical pulmonary hypertension (PH) has been acknowledged as a non-risk factor for deceased donor OLT. Given that PH measurement requires cardiac catheterization, the tricuspid regurgitation pressure gradient (TRPG) measured by echocardiography is used to screen for PH and congestive pressure to the liver. We investigated the impact of a subclinical high TRPG on the survival of small grafted living donor liver transplantation (LDLT). Methods: We retrospectively analyzed 84 LDLT candidates. Patients exhibiting a TRPG ≥25 mmHg on echocardiography were categorized as potentially having liver congestion (subclinical high TRPG; n=34). The mean pulmonary artery pressure (mPAP) measured after general anesthesia with FIO20.6 (mPAP-FIO20.6) was also assessed. Patients exhibiting pO2<80 mmHg and an alveolar-arterial oxygen gradient (AaDO2)≥15 mmHg were categorized as potentially having HPS (subclinical HPS; n=29). The clinical course after LDLT was investigated according to subclinical high TRPG. Results: A subclinical high TRPG (p=0.012) and older donor age (p=0.008) were correlated with a poor 40-month survival. Although a higher mPAP-FIO20.6 was expected to correlate with a worse survival, a high mPAP-FIO20.6 with a low TRPG was associated with high frequency complicating subclinical HPS and a good survival, suggesting a reduction in the PH pressure via pulmonary shunt. Conclusion: In cirrhosis patients, mPAP-FIO20.6 may not accurately reflect the congestive pressure to the liver, as the pressure might escape via pulmonary shunt. A subclinical high TRPG is an important marker for predicting a worse survival after LDLT, possibly reflecting congestive pressure to the grafted small liver.",
keywords = "Hepatopulmonary syndrome, Living donor related liver transplantation, Portopulmonary hypertension, Tricuspid regurgitation pressure gradient",
author = "Yosuke Saragai and Akinobu Takaki and Yuzo Umeda and Takashi Matsusaki and Tetsuya Yasunaka and Atsushi Oyama and Ryuji Kaku and Kazufumi Nakamura and Ryuichi Yoshida and Daisuke Nobuoka and Takashi Kuise and Kosei Takagi and Takuya Adachi and Nozomu Wada and Yasuto Takeuchi and Kazuko Koike and Fusao Ikeda and Hideki Ohnishi and Hidenori Shiraha and Shinichiro Nakamura and Hiroshi Morimatsu and Hiroshi Itoh and Toshiyoshi Fujiwara and Takahito Yagi and Hiroyuki Okada",
year = "2018",
month = "5",
day = "15",
doi = "10.1186/s12876-018-0793-z",
language = "English",
volume = "18",
journal = "BMC Gastroenterology",
issn = "1471-230X",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - A subclinical high tricuspid regurgitation pressure gradient independent of the mean pulmonary artery pressure is a risk factor for the survival after living donor liver transplantation

AU - Saragai, Yosuke

AU - Takaki, Akinobu

AU - Umeda, Yuzo

AU - Matsusaki, Takashi

AU - Yasunaka, Tetsuya

AU - Oyama, Atsushi

AU - Kaku, Ryuji

AU - Nakamura, Kazufumi

AU - Yoshida, Ryuichi

AU - Nobuoka, Daisuke

AU - Kuise, Takashi

AU - Takagi, Kosei

AU - Adachi, Takuya

AU - Wada, Nozomu

AU - Takeuchi, Yasuto

AU - Koike, Kazuko

AU - Ikeda, Fusao

AU - Ohnishi, Hideki

AU - Shiraha, Hidenori

AU - Nakamura, Shinichiro

AU - Morimatsu, Hiroshi

AU - Itoh, Hiroshi

AU - Fujiwara, Toshiyoshi

AU - Yagi, Takahito

AU - Okada, Hiroyuki

PY - 2018/5/15

Y1 - 2018/5/15

N2 - Background: Portopulmonary hypertension (POPH) is characterized by pulmonary vasoconstriction, while hepatopulmonary syndrome (HPS) is characterized by vasodilation. Definite POPH is a risk factor for the survival after orthotopic liver transplantation (OLT), as the congestive pressure affects the grafted liver, while subclinical pulmonary hypertension (PH) has been acknowledged as a non-risk factor for deceased donor OLT. Given that PH measurement requires cardiac catheterization, the tricuspid regurgitation pressure gradient (TRPG) measured by echocardiography is used to screen for PH and congestive pressure to the liver. We investigated the impact of a subclinical high TRPG on the survival of small grafted living donor liver transplantation (LDLT). Methods: We retrospectively analyzed 84 LDLT candidates. Patients exhibiting a TRPG ≥25 mmHg on echocardiography were categorized as potentially having liver congestion (subclinical high TRPG; n=34). The mean pulmonary artery pressure (mPAP) measured after general anesthesia with FIO20.6 (mPAP-FIO20.6) was also assessed. Patients exhibiting pO2<80 mmHg and an alveolar-arterial oxygen gradient (AaDO2)≥15 mmHg were categorized as potentially having HPS (subclinical HPS; n=29). The clinical course after LDLT was investigated according to subclinical high TRPG. Results: A subclinical high TRPG (p=0.012) and older donor age (p=0.008) were correlated with a poor 40-month survival. Although a higher mPAP-FIO20.6 was expected to correlate with a worse survival, a high mPAP-FIO20.6 with a low TRPG was associated with high frequency complicating subclinical HPS and a good survival, suggesting a reduction in the PH pressure via pulmonary shunt. Conclusion: In cirrhosis patients, mPAP-FIO20.6 may not accurately reflect the congestive pressure to the liver, as the pressure might escape via pulmonary shunt. A subclinical high TRPG is an important marker for predicting a worse survival after LDLT, possibly reflecting congestive pressure to the grafted small liver.

AB - Background: Portopulmonary hypertension (POPH) is characterized by pulmonary vasoconstriction, while hepatopulmonary syndrome (HPS) is characterized by vasodilation. Definite POPH is a risk factor for the survival after orthotopic liver transplantation (OLT), as the congestive pressure affects the grafted liver, while subclinical pulmonary hypertension (PH) has been acknowledged as a non-risk factor for deceased donor OLT. Given that PH measurement requires cardiac catheterization, the tricuspid regurgitation pressure gradient (TRPG) measured by echocardiography is used to screen for PH and congestive pressure to the liver. We investigated the impact of a subclinical high TRPG on the survival of small grafted living donor liver transplantation (LDLT). Methods: We retrospectively analyzed 84 LDLT candidates. Patients exhibiting a TRPG ≥25 mmHg on echocardiography were categorized as potentially having liver congestion (subclinical high TRPG; n=34). The mean pulmonary artery pressure (mPAP) measured after general anesthesia with FIO20.6 (mPAP-FIO20.6) was also assessed. Patients exhibiting pO2<80 mmHg and an alveolar-arterial oxygen gradient (AaDO2)≥15 mmHg were categorized as potentially having HPS (subclinical HPS; n=29). The clinical course after LDLT was investigated according to subclinical high TRPG. Results: A subclinical high TRPG (p=0.012) and older donor age (p=0.008) were correlated with a poor 40-month survival. Although a higher mPAP-FIO20.6 was expected to correlate with a worse survival, a high mPAP-FIO20.6 with a low TRPG was associated with high frequency complicating subclinical HPS and a good survival, suggesting a reduction in the PH pressure via pulmonary shunt. Conclusion: In cirrhosis patients, mPAP-FIO20.6 may not accurately reflect the congestive pressure to the liver, as the pressure might escape via pulmonary shunt. A subclinical high TRPG is an important marker for predicting a worse survival after LDLT, possibly reflecting congestive pressure to the grafted small liver.

KW - Hepatopulmonary syndrome

KW - Living donor related liver transplantation

KW - Portopulmonary hypertension

KW - Tricuspid regurgitation pressure gradient

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U2 - 10.1186/s12876-018-0793-z

DO - 10.1186/s12876-018-0793-z

M3 - Article

C2 - 29764373

AN - SCOPUS:85047092351

VL - 18

JO - BMC Gastroenterology

JF - BMC Gastroenterology

SN - 1471-230X

IS - 1

M1 - 62

ER -