The relationship between preoperative pulmonary hypertension risk in liver transplant and vascular and biliary complications in the postoperative period.

PURPOSE: Liver transplantation (LT) is the gold standard definitive treatment for end-stage liver disease (ESLD). In patients with ESLD, preoperative pulmonary hypertension (PHT) secondary to the primary liver pathology is a common complication that causes high mortality and morbidity. This study aimed to determine whether thrombosis, hemorrhage, stenosis, occlusion, and biliary system complications may be indirectly affected by this vascular complication.

METHODS

This study retrospectively screened patients undergoing LT at our hospital between 2017 and 2024. A total of 265 patients were included. Preoperative PHT was assessed using transthoracic echocardiography-derived systolic pulmonary arterial pressure measurements, whereas post-transplant computed tomography scans were reviewed for vascular and biliary complications.

RESULTS

The portal vein complications in the PHT group (17.5%) were higher than those in the non-PHT group (9.4%). In the multivariate logistic regression analysis examining the relationship between PHT level and complications, a significant association with portal vein complications was found. No difference was found between the two groups regarding hepatic vein complications (P = 0.496). The incidence of biliary complications in patients with PHT (41.3%) was similar to that in those without PHT (41.1%) (P = 0.980). There was no statistically significant relationship between PHT levels (normal, mild, moderate/severe) and the distribution of hepatic artery complications (P = 0.194).

CONCLUSION

Moderate-to-severe PHT levels were found to be associated with a significantly increased risk of portal vein complications. We believe caution is warranted, as the presence of preoperative PHT can significantly increase the risk of post-LT complications.

CLINICAL SIGNIFICANCE: Changes in mediator balance in PHT lead to systemic vascular remodeling and, consequently, systemic vasoconstriction. We believe that this condition may negatively affect graft vascularity in patients undergoing LT, thereby increasing vascular and biliary complications. This study found that PHT is associated with the risk of portal vein complications.