Korean J Anesthesiol.  2015 Feb;68(1):83-86. 10.4097/kjae.2015.68.1.83.

What do we take consideration in the patient who has an unpredicted severe portopulmonary hypertension in liver transplantation?: a case report

• Koh H
• Ahn S
• Lee J

• KMID: 2236195
• DOI: http://doi.org/10.4097/kjae.2015.68.1.83

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.

Keyword

Ascites; Liver transplantation; Nitroglycerin; Portopulmonary hypertension

MeSH Terms

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
Dobutamine
Iloprost
Milrinone
Nitric Oxide
Nitroglycerin