LETTER
Lung Dysfunction and Chronic Liver Disease
Eric M. Yoshida, MD;
Siegfried R. Erb, MD; and
Charles H. Scudamore, MD
1 February 1996 | Volume 124 Issue 3 | Page 369
TO THE EDITOR:
In their excellent article, Lange and Stoller [1] state that cirrhosis-associated pulmonary hypertension is less likely to reverse after liver transplantation. Pulmonary hypertension associated with liver disease (portopulmonary hypertension) is an entity distinct from the hepatopulmonary syndrome, which is characterized by low to normal pulmonary artery pressures.
The literature on liver transplantation and portopulmonary hypertension is scant. Although significant mortality was initially reported in liver transplant recipients with a history of pulmonary hypertension [2], more recent reports have been more promising. We previously reported successful amelioration of pulmonary hypertension after liver transplantation in a patient with portopulmonary hypertension [3]. Since then, we have documented a sustained resolution in pulmonary artery pressure 4 years after transplantation. After our initial report, two other centers have subsequently described reversal of pulmonary hypertension after liver transplantation [4, 5]. The collective experience described in these reports [3-5] is that of persistent pulmonary hypertension in the immediate perioperative period, followed by reversal over several months.
Our experience, and that of the other centers, suggests that a reversible component of portopulmonary hypertension exists. Liver transplantation may be of benefit to patients without end-stage pulmonary arterial fibrosis and with preserved cardiac function.
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Author and Article Information
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University of British Columbia; Vancouver, British Columbia; Canada
1. Lange PA, Stoller JK. The hepatopulmonary syndrome. Ann Intern Med. 1995; 122:521-9.
2. Hamdani R, Chelluri L, Selby R, Kramer D, Kang Y, Wood S, et al. Sudden death in patients with pulmonary hypertension undergoing orthotopic liver transplantation [Abstract]. Hepatology. 1991; 14:282A.
3. Yoshida EM, Erb SR, Plugfelder PW, Ostrow DN, Ricci DR, Ghent CN, et al. Single lung versus liver transplantation for the treatment of portopulmonary hypertension: a comparison of two patients. Transplantation. 1993; 55:688-90.
4. Scott V, De Wolf A, Kang Y, Martin M, Selby R, Fung J, et al. Reversibility of pulmonary hypertension after liver transplantation: a case report. Transplant Proc. 1993; 25:1789-90.
5. Koneru B, Ahmed S, Weisse AB, Grant GP, McKim AK. Resolution of pulmonary hypertension of cirrhosis after liver transplantation. Transplantation. 1994; 58:1133-5.
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