Sildenafil Therapy Is Associated with Improved Hemodynamics in Liver Transplantation Candidates with Pulmonary Arterial Hypertension
Sildenafil Therapy Is Associated with Improved Hemodynamics in Liver Transplantation Candidates with Pulmonary Arterial Hypertension
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DOI：
10.1002/lt.21533
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发表时间：
2009-01-01
影响因子：
4.6
通讯作者：
White, R. James
中科院分区：
文献类型：
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作者：
Gough, Michael S.;White, R. James
肺动脉高压伴门脉高压发生在约5%的肝移植患者中。需要治疗以促进安全移植，口服肺血管扩张剂尚未对这种疾病进行前瞻性评估。本研究的目的是确定连续队列接受西地那非作为门脉高压一线治疗的患者的血流动力学结局。我们在罗切斯特大学确定了肝移植团队转诊的连续患者。所有患者均经导管证实患有疾病，并接受西地那非治疗。如果患者没有进行随访导管插入术，则将其从分析中排除。首次随访时肺血管阻力的变化是主要结局。11名患者开始西地那非，9名患者在3年期间进行了随访右心导管插入术。每例患者的肺血管阻力都有所下降;作为一个组，平均值从575达因/秒/厘米下降到375达因/秒/厘米（5）。9例患者中有4例达到了平均肺动脉压
Pulmonary arterial hypertension associated with portal hypertension occurs in about 5% of patients being evaluated for liver transplantation. Treatment is required to facilitate safe transplantation, and oral pulmonary vasodilators have yet to be prospectively evaluated for this disease. The objective of this study was to determine the hemodynamic outcome in a consecutive cohort of patients offered sildenafil as first-line treatment for portopulmonary hypertension. We identified consecutive patients at the University of Rochester referred by the liver transplant team. All had catheter-confirmed disease and were treated with sildenafil. Patients were excluded from analysis if they did not have follow-up catheterizations. The change in pulmonary vascular resistance at the time of first follow-up was the primary outcome. Eleven patients began sildenafil, and 9 had follow-up right heart catheterizations during a 3-year period. Pulmonary vascular resistance dropped in each patient; as a group, the mean dropped from 575 to 375 dynes/second/cm(5). Four of 9 patients achieved a mean pulmonary artery pressure