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Intravenous iloprost bridging to orthotopic liver transplantation in portopulmonary hypertension

Depts of ¹ Internal Medicine, ² Anaesthesiology and ³ Surgery, University Hospital, Zurch, Switzerland.

CORRESPONDENCE: R. Speich, Dept of Internal Medicine, University Hospital, Raemistrasse 100, CH-8091, Zurich, Switzerland. Fax: 41 12554451. E-mail: klinspr@usz.unizh.ch

Keywords: Epoprostenol, iloprost, liver cirrhosis, liver transplantation, portopulmonary hypertension, pulmonary hypertension

Received: December 2, 2003
Accepted April 8, 2004

Abstract

Portopulmonary hypertension (PPHTN) is associated with poor prognosis and high perioperative mortality after orthotopic liver transplantation.

This study documents the first case of a patient with PPHTN who was successfully bridged to orthotopic liver transplantation with i.v. iloprost, a stable prostacyclin analogue. The PPHTN had resolved completely 4 months after successful transplantation.

In conclusion, portopulmonary hypertension is a relative contraindication to orthotopic liver transplantation, which should be attempted only if pulmonary haemodynamics improve with prostanoids. In this context, iloprost may be a valuable alternative to epoprostenol.