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Vasomodulators and Liver Transplantation for Portopulmonary Hypertension: Evidence From a Systematic Review and Meta-Analysis.
- Source :
-
Hepatology (Baltimore, Md.) [Hepatology] 2020 Nov; Vol. 72 (5), pp. 1701-1716. Date of Electronic Publication: 2020 Oct 19. - Publication Year :
- 2020
-
Abstract
- Background and Aims: Untreated portopulmonary hypertension (PoPH) carries a poor prognosis. Previous reports have described vasomodulator (VM) therapy and liver transplantation (LT) as treatment options. We aimed to provide summary estimates on the endpoints of pulmonary hemodynamics and survival in patients with PoPH, treated with different modalities.<br />Approach and Results: We performed a systematic review with meta-analysis of mainly observational and case-control studies describing no treatment, VM, LT, or VM + LT in patients with PoPH. Twenty-six studies (1,019 patients) were included. Both VM and VM + LT improve pulmonary hemodynamics. A substantial proportion of patients treated with VM become eligible for LT (44%; 95% confidence interval [CI], 31-58). Pooled estimates for 1-, and 3-year postdiagnosis survival in patients treated with VM were 86% (95% CI, 81-90) and 69% (95% CI, 50-84) versus 82% (95% CI, 52-95) and 67% (95% CI, 53-78) in patients treated with VM + LT. Of note, studies reporting on the effect of VM mainly included Child-Pugh A/B patients, whereas studies reporting on VM + LT mainly included Child-Pugh B/C. Seven studies (238 patients) included both patients who received VM only and patients who received VM + LT. Risk of death in VM-only-treated patients was significantly higher than in patients who could be transplanted as well (odds ratio, 3.5; 95% CI, 1.4-8.8); however, importantly, patients who proceeded to transplant had been selected very strictly. In 50% of patients, VM can be discontinued post-LT (95% CI, 38-62).<br />Conclusions: VM and VM + LT both improve pulmonary hemodynamics and prognosis in PoPH. In a strictly selected subpopulation of cases where LT is indicated based on severe liver disease and where LT is considered safe and feasible, treatment with VM + LT confers a better prognosis. Considering successful VM, 44% can proceed to LT, with half being able to postoperatively stop medication.<br /> (© 2020 by the American Association for the Study of Liver Diseases.)
- Subjects :
- Case-Control Studies
Endothelin Receptor Antagonists pharmacology
Hemodynamics drug effects
Hemodynamics physiology
Humans
Hypertension, Portal complications
Hypertension, Portal mortality
Hypertension, Portal physiopathology
Hypertension, Pulmonary complications
Hypertension, Pulmonary mortality
Hypertension, Pulmonary physiopathology
Observational Studies as Topic
Prognosis
Randomized Controlled Trials as Topic
Survival Rate
Treatment Outcome
Vasodilator Agents pharmacology
Endothelin Receptor Antagonists therapeutic use
Hypertension, Portal therapy
Hypertension, Pulmonary therapy
Liver Transplantation statistics & numerical data
Vasodilator Agents therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1527-3350
- Volume :
- 72
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Hepatology (Baltimore, Md.)
- Publication Type :
- Academic Journal
- Accession number :
- 32017176
- Full Text :
- https://doi.org/10.1002/hep.31164