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Volume-mediated pulmonary responses in liver transplant candidates.

Publication ,  Journal Article
Kuo, PC; Schroeder, RA; Vagelos, RH; Valantine, H; Garcia, G; Alfrey, EJ; Haddow, G; Dafoe, DC
Published in: Clin Transplant
December 1996

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.

Duke Scholars

Published In

Clin Transplant

ISSN

0902-0063

Publication Date

December 1996

Volume

10

Issue

6 Pt 1

Start / End Page

521 / 527

Location

Denmark

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Surgery
  • Smoking
  • Sensitivity and Specificity
  • Risk Assessment
  • Rehydration Solutions
  • Radiography, Thoracic
  • Pulmonary Wedge Pressure
  • Pulmonary Artery
  • Prospective Studies
 

Citation

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Kuo, P. C., Schroeder, R. A., Vagelos, R. H., Valantine, H., Garcia, G., Alfrey, E. J., … Dafoe, D. C. (1996). Volume-mediated pulmonary responses in liver transplant candidates. Clin Transplant, 10(6 Pt 1), 521–527.
Kuo, P. C., R. A. Schroeder, R. H. Vagelos, H. Valantine, G. Garcia, E. J. Alfrey, G. Haddow, and D. C. Dafoe. “Volume-mediated pulmonary responses in liver transplant candidates.Clin Transplant 10, no. 6 Pt 1 (December 1996): 521–27.
Kuo PC, Schroeder RA, Vagelos RH, Valantine H, Garcia G, Alfrey EJ, et al. Volume-mediated pulmonary responses in liver transplant candidates. Clin Transplant. 1996 Dec;10(6 Pt 1):521–7.
Kuo, P. C., et al. “Volume-mediated pulmonary responses in liver transplant candidates.Clin Transplant, vol. 10, no. 6 Pt 1, Dec. 1996, pp. 521–27.
Kuo PC, Schroeder RA, Vagelos RH, Valantine H, Garcia G, Alfrey EJ, Haddow G, Dafoe DC. Volume-mediated pulmonary responses in liver transplant candidates. Clin Transplant. 1996 Dec;10(6 Pt 1):521–527.
Journal cover image

Published In

Clin Transplant

ISSN

0902-0063

Publication Date

December 1996

Volume

10

Issue

6 Pt 1

Start / End Page

521 / 527

Location

Denmark

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Surgery
  • Smoking
  • Sensitivity and Specificity
  • Risk Assessment
  • Rehydration Solutions
  • Radiography, Thoracic
  • Pulmonary Wedge Pressure
  • Pulmonary Artery
  • Prospective Studies