Rapid assessment and safe management of severe pulmonary hypertension with milrinone during orthotopic liver transplantation

Kyota Fukazawa, Liviu C. Poliac, Ernesto A. Pretto

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

The incidence of porto-pulmonary hypertension (PPHN) in patients with end stage liver disease is 8.5%. Evidence indicates that proceeding with orthotopic liver transplantation (OLT) in patients diagnosed with severe PPHN (mean pulmonary artery pressure [mPAP] > 45 mmHg) at the time of OLT surgery is associated with high perioperative mortality. We describe a case of severe PPHN that was diagnosed by right heart catheterization at the time of surgery. We quickly determined the reversibility of PPHN with a bolus of milrinone and proceeded with OLT. Further episodes of pulmonary hypertension were successfully managed with continuous milrinone infusion and transesophageal echocardiography monitoring. Reversibility via vasodilator trial after identification of high pulmonary artery pressures (PAP) may be an important indication of the feasibility of OLT. Milrinone may be useful for the rapid identification of the reversibility of high PAP and may be an effective agent to control abrupt increases in PAP during OLT.

Original languageEnglish (US)
Pages (from-to)515-519
Number of pages5
JournalClinical Transplantation
Volume24
Issue number4
DOIs
StatePublished - Jul 1 2010

Keywords

  • Liver transplantation
  • Milrinone
  • Porto-pulmonary hypertension
  • Pulmonary hypertension
  • Reversibility
  • Vasodilator

ASJC Scopus subject areas

  • Transplantation

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