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Does Portopulmonary Hypertension Impede Liver Transplantation in Cirrhotic Patients? A French Multicentric Retrospective Study. Transplantation 2018; 102:616-622. [PMID: 29077657 DOI: 10.1097/tp.0000000000001981] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Portopulmonary hypertension is defined by the presence of pulmonary arterial hypertension associated with portal hypertension. Its presence is a major stake for cirrhotic patients requiring liver transplantation (LT), with increased postoperative mortality and unpredictable evolution after transplantation. The aim was to study outcomes after liver transplantation in patients with portopulmonary hypertension and to identify factors associated with normalization of pulmonary hypertension. METHODS Patients with portopulmonary hypertension who underwent LT between 2008 and 2016 in 8 French centers were retrospectively included. Pulmonary artery pressure was established by right heart catheterization before and after LT. Primary endpoint was the normalization of pulmonary artery pressure after LT. RESULTS Twenty-three patients who received liver transplant between 2008 and 2016 were included. Two (8.7%) patients died in the immediate posttransplant period from right heart failure. With appropriate vasoactive medical treatment and LT, pulmonary arterial pressure was normalized in 14 patients (60.8%), demonstrating recovery from portopulmonary hypertension. In univariate analysis, the use of vasoactive combination therapy was the only prognostic factor for pulmonary arterial hypertension normalization after LT. CONCLUSIONS Treatment of portopulmonary hypertension with a combination of vasoactive drugs allows LT with acceptable postoperative cardiovascular-related mortality and normalization of pulmonary hypertension in the majority of the patients.
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Défaillance cardiaque dans l’hypertension artérielle pulmonaire idiopathique: les pièges à éviter. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-013-0825-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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A comparative study of PGI2 mimetics used clinically on the vasorelaxation of human pulmonary arteries and veins, role of the DP-receptor. Prostaglandins Other Lipid Mediat 2013; 107:48-55. [DOI: 10.1016/j.prostaglandins.2013.07.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/18/2013] [Accepted: 07/02/2013] [Indexed: 01/11/2023]
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Boniface S, Reynaud-Gaubert M. Endothelin receptor antagonists -- their role in pulmonary medicine. Rev Mal Respir 2011; 28:e94-e107. [PMID: 22099418 DOI: 10.1016/j.rmr.2009.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 07/02/2009] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Understanding of the function of endothelin-1 in the pathophysiology of endothelial disease, in particular pulmonary arterial hypertension (PAH), has paved the way for the development of endothelin-receptor antagonists (ERAs) and explains the leading role they now play in the treatment armamentarium for this disease. BACKGROUND Three active ERA drugs (bosentan, sitaxentan, ambrisentan) are currently approved for the treatment of PAH in France. Several randomised clinical trials have demonstrated their efficacy and safety in PAH. PERSPECTIVES AND CONCLUSION Besides its vasoconstrictor effect, endothelin-1 (ET-1) plays a pivotal role in cell proliferation and apoptosis. ERAs are innovative drugs potentially useful in some pulmonary disorders such as idiopathic pulmonary fibrosis or systemic sclerosis, even though the preliminary results published remain insufficient or controversial. CONCLUSION ERAs play a major role in the management of pulmonary vascular disease. Other drugs, still under study, could prove useful in the treatment of infiltrating pneumonias.
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Affiliation(s)
- S Boniface
- Cabinet de Pneumologie, 4, avenue de Delphes, 13006 Marseille, France
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Montani D, Humbert M. La place des antagonistes des récepteurs de l’endothéline dans les nouvelles recommandations européennes pour la prise en charge de l’hypertension artérielle pulmonaire. Rev Mal Respir 2010; 27:103-5. [DOI: 10.1016/j.rmr.2009.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 12/04/2009] [Accepted: 12/04/2009] [Indexed: 10/19/2022]
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Les antagonistes des récepteurs de l’endothéline : leur place dans les maladies pulmonaires. Rev Mal Respir 2009; 26:1075-90. [DOI: 10.1016/s0761-8425(09)73534-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Marie I, Bekri S, Lévesque H. Endothéline 1 et sélectivité des antagonistes des récepteurs de l’endothéline 1 : to B or not to B ? Rev Med Interne 2008; 29:263-8. [DOI: 10.1016/j.revmed.2008.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 01/05/2008] [Indexed: 10/22/2022]
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Synthèse : traitement de l’hypertension artérielle pulmonaire. Rev Mal Respir 2008. [DOI: 10.1016/s0761-8425(08)74835-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Canuet M, Chaouat A. Les effets indésirables du cathétérisme cardiaque droit chez les patients ayant une hypertension pulmonaire sont exceptionnels lorsque cet examen est realize dans un centre expert. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chaouat A, Canuet M, Gomez E, Chabot F, Weitzenblum E. Hypertension pulmonaire des affections respiratoires chroniques. Rev Mal Respir 2007; 24:509-21. [PMID: 17468707 DOI: 10.1016/s0761-8425(07)91573-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pulmonary hypertension of chronic respiratory disease is defined as elevation of the mean resting pulmonary artery pressure to over 20 mm Hg. It is the commonest cause of pre-capillary pulmonary hypertension on account of the high prevalence of chronic obstructive pulmonary disease. It is primarily due to alveolar hypoxia that leads to remodelling of the distal pulmonary vasculature and consequently to an increase in pulmonary resistance. It is not as severe as idiopathic pulmonary hypertension. The mean pulmonary artery pressure is usually moderately increased (20-35 mm Hg) when patients are seen during a stable period of the disease. There are, however, more severe cases of pulmonary hypertension called, in some cases, disproportionate but these are uncommon. Increased right ventricular afterload can lead to the development of right ventricular failure that is a definite prognostic factor. The clinical symptoms of pulmonary hypertension are at a secondary level compared with those of the causal disease. Non-invasive diagnosis depends on Doppler echocardiography. Currently the most effective treatment is long term oxygen therapy (16-18 hr/24 hr). This improves or, at least stabilises, the pulmonary hypertension.
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Affiliation(s)
- A Chaouat
- Service des Maladies Respiratoires et Réanimation Respiratoire, Hôpital de Brabois, CHU de Nancy, France.
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Jais X, Dartevelle P, Parent F, Sitbon O, Humbert M, Fadel E, Mussot S, Cabrol S, Le Pavec J, Sztrymf B, Tcherakian C, Musset D, Maitre S, Simonneau G. Hypertension pulmonaire postembolique. Rev Mal Respir 2007; 24:497-508. [PMID: 17468706 DOI: 10.1016/s0761-8425(07)91572-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease characterized by the persistence of thromboemboli obstructing the pulmonary arteries as an organized tissue. The consequence is an increase in pulmonary vascular resistance resulting in pulmonary hypertension (PH) and progressive right heart failure. BACKGROUND It is difficult to recognize the postembolic nature of PH because there is no known history of thromboembolic disease in more than 50% of cases. Diagnosis is based on the presence of mismatched segmental defects in the ventilation-perfusion scanning. When CTEPH is suspected, pulmonary angiography and high-resolution CT scan are required to establish the diagnosis and to assess the operability. Pulmonary angiography is always performed in conjunction with a diagnostic right heart catheterization, which is required to confirm the diagnosis of PH and to determine the degree of hemodynamic impairement. If there is a good correlation between the pulmonary vascular resistance and the anatomical obstruction, pulmonary endarterectomy (PEA) must be proposed. Otherwise, vasodilator and antiproliferative treatments and lung transplantation represent interesting alternatives. VIEWPOINT AND CONCLUSION PEA remains the treatment of choice for eligible patients. Nevertheless, there is a need to conduct randomized trials to assess the efficacy of novel medical therapies in some situations: (1) in inoperable CTEPH due to distal lesions, (2) before PEA (therapeutic bridge) in patients who are considered "high risk" due to extremely poor hemodynamics, (3) in patients with persistent pulmonary hypertension after surgery.
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Affiliation(s)
- X Jais
- Centre de Référence de l'Hypertension Artérielle Pulmonaire, Unité Propre de Recherche de l'Enseignement Supérieur EA2705, Hôpital Antoine-Béclère, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France.
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Dinh-Xuan AT, Chaouat A. L’hypertension artérielle pulmonaire : de nouveaux concepts pour une « vieille » maladie. Rev Mal Respir 2007; 24:415-6. [PMID: 17468698 DOI: 10.1016/s0761-8425(07)91564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Dot JM, Sztrymf B, Yaïci A, Dorfmüller P, Capron F, Parent F, Jaïs X, Sitbon O, Simonneau G, Humbert M. Hypertension artérielle pulmonaire postembolique tumorale. Rev Mal Respir 2007; 24:359-66. [PMID: 17417176 DOI: 10.1016/s0761-8425(07)91070-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is rare in the presence of malignancy and tumour embolisation is one of several possible pathological mechanisms. CASE REPORTS We report our experience of 5 clinical cases and undertake a literature revue of the pathophysiological mechanisms and of the possible diagnostic and therapeutic approaches. CONCLUSIONS Neoplastic PAH due to tumour micro-emboli is rare and the diagnosis difficult to establish. Cytological examination of pulmonary arterial blood could allow early institution of appropriate chemotherapy and lead to an improvement in the grave prognosis of this condition.
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Affiliation(s)
- J M Dot
- Centre national de référence de l'hypertension pulmonaire, UPRES EA 2705, service de pneumologie et réanimation respiratoire, Hôpital Antoine Béclère, Assistance publique-hôpitaux de Paris, université Paris Sud, Clamart, France
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Cui B, Yu F, Dai DZ, Zhang TT, Tang XY, Dai Y. CPU0123, a novel endothelin receptor antagonist, relieves hypoxic pulmonary hypertension in rats by suppressing excessive ET-ROS pathway. Drug Dev Res 2007. [DOI: 10.1002/ddr.20164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
INTRODUCTION Porto-pulmonary hypertension (PoPH) is the association of pulmonary artery hypertension and portal hypertension. The diagnosis of PoPH is based on pulmonary haemodynamic criteria, obtained via right heart catheterisation, including an increase in mean pulmonary arterial pressure (> 25 mmHg) and in pulmonary vascular resistance (> 240 dyn.s.cm-5). STATE OF THE ART The exact pathophysiological mechanisms of PoPH are unknown. However, since PoPH has been reported in patients with non-hepatic portal hypertension, the factor that determines the development must be portal hypertension rather than liver disease per se. Moreover, no simple relationship has been identified between the degree of hepatic impairment and the severity of PoPH. The clinical presentation is non-specific with haemodynamic failure occurring at the end stage. As a consequence, screening by annual transthoracic echocardiography is highly recommended in potential liver transplant candidates. Therapy with prostacyclin analogues may partially relieve pulmonary arterial hypertension (PAH). Liver transplantation has an uncertain effect in PoPH and because PoPH is associated with a high perioperative mortality, moderate to severe PoPH remains a contraindication for liver transplantation. PERSPECTIVES AND CONCLUSIONS Recent advances in the management of PoPH have improved the prognosis. The safety and efficacy of oral endothelin receptor antagonists and oral phosphodiesterase inhibitors is currently under evaluation. A therapeutic approach utilising combinations of drugs should provide better long-term results.
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Affiliation(s)
- F Chabot
- Service des Maladies Respiratoires et Réanimation Respiratoire, CHU Nancy, Université Henri Poincaré, Nancy, France.
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Dinh-Xuan AT. Perfusion pulmonaire, espace mort physiologique et hypertension artérielle pulmonaire à l’exercice : la course au recrutement. Rev Mal Respir 2006; 23:111-3. [PMID: 16788433 DOI: 10.1016/s0761-8425(06)71472-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weitzenblum E. Prise en charge de l’hypertension artérielle pulmonaire idiopathique. Rev Mal Respir 2005. [DOI: 10.1016/s0761-8425(05)85665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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