Korean J Anesthesiol.  2008 Jan;54(1):102-108. 10.4097/kjae.2008.54.1.102.

Perioperative Combined Use of Sildenafil and Inhaled Iloprost for Moderate Portopulmonary Hypertension in a Patient Undergoing Liver Transplantation: A case report

• Kim DK
• Kim HK
• Lim JA
• Jeong SM
• Jang SW
• Yun IJ

• KMID: 2236582
• DOI: http://doi.org/10.4097/kjae.2008.54.1.102

Abstract

Moderate to severe pulmonary hypertension, mean pulmonary arterial pressure (mPAP) > 35 mmHg, in cirrhotic patients is usually considered an absolute contraindication to orthotopic liver transplantation (OLT) because of unacceptably high mortality. We present the case of successful OLT in a cirrhotic patient with a mPAP of 42 mmHg and a pulmonary vascular resistance (PVR) of 298 dyne . sec . cm(-5) preoperatively. He was treated with oral sildenafil (Viagra(R)) and inhaled iloprost (Ventavis(R)) for 45 days and then his mPAP and PVR were reduced to 33 mmHg and 206 dyne . sec . cm(-5) at the time of transplantation. During OLT, his mPAP was stable of 28?38 mmHg with the combined use of sildenafil via a nasogastric tube and iloprost via a nebulizer. His hemodynamic parameters were stable and significant postoperative bleeding was not noticed throughout his stay in the intensive care unit. Thereafter, he was transferred to general ward without any cardio-respiratory problems on 7th postoperative days.

Keyword

iloprost; liver transplantation; sildenafil; pulmonary hypertension

MeSH Terms

Arterial Pressure
Hemodynamics
Hemorrhage
Humans
Hypertension
Hypertension, Pulmonary
Iloprost
Intensive Care Units
Liver
Liver Transplantation
Nebulizers and Vaporizers
Patients' Rooms
Piperazines
Purines
Sulfones
Transplants
Vascular Resistance
Sildenafil Citrate
Iloprost
Piperazines
Purines
Sulfones