Portopulmonary syndrome
OVERVIEW
- Portopulmonary Syndrome is NOT considered contraindication to liver transplantation
- affects ~20% of pre-transplant patients
- usually due to increased blood flow through the lungs without increased resistance
- ~5% have pulmonary HTN with high PVR, which is worse
DIAGNOSTIC CRITERIA
- Portal hypertension
- MPAP > 25 mmHg
- PAOP < 15 mmHg
- PVR > 120 dynes/s per cm-5
MANAGEMENT
- liver transplantation if appropriate
- epoprostenol post-op (PGI2 analogue) for 3 months -> remodelling
- progressive thrombocytopenia and splenomegaly may occur
PROGNOSIS
- can progress after transplantation
- higher the MPAP and PVR (and TPG = transpulmonary gradient) -> higher the mortality
- Some consider f MPAP >50 mmHg some advise cancellation of liver transplantation as close to 100% mortality
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC