What do we take consideration in the patient who has an unpredicted severe portopulmonary hypertension in liver transplantation?: a case report.
10.4097/kjae.2015.68.1.83
- Author:
Hyunjung KOH
1
;
Seulgi AHN
;
Jaemin LEE
Author Information
1. Department of Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, Korea. jmlee@catholic.ac.kr
- Publication Type:Case Report
- Keywords:
Ascites;
Liver transplantation;
Nitroglycerin;
Portopulmonary hypertension
- MeSH:
Ascites;
Dobutamine;
Drainage;
Female;
Hemodynamics;
Humans;
Hypertension*;
Iloprost;
Liver Transplantation*;
Living Donors;
Middle Aged;
Milrinone;
Mortality;
Nitric Oxide;
Nitroglycerin;
Prognosis;
Pulmonary Artery;
Reference Values;
Sildenafil Citrate
- From:Korean Journal of Anesthesiology
2015;68(1):83-86
- CountryRepublic of Korea
- Language:English
-
Abstract:
Severe portopulmonary hypertension (PPHT) is considered a contraindication for liver transplantation (LT) because of the associated high mortality and poor prognosis. We report the case of a 57-year-old cirrhotic woman with severe PPHT (mean pulmonary artery pressure [mPAP] > 65 mmHg), who underwent a successful living donor LT. Intra-operative use of inhaled iloprost, milrinone, dobutamine, and postoperative use of inhaled nitric oxide and oral sildenafil failed to lower the pulmonary artery pressure (PAP). The patient responded only to nitroglycerin and drainage of massive ascites. Meticulous intra-operative volume control, which included minimizing blood loss and subsequent transfusion, was carried out. The use of vasopressors, which may have elevated the PAP, was strictly restricted. Intra-operative PAP did not show an increase, and the hemodynamics was maintained within relatively normal range, compared to the preoperative state. The patient was discharged without any complications or related symptoms.
