Impact of medical therapy on liver transplant eligibility in patients with portopulmonary hypertension: a systematic review.

IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY
Matthew T Siuba, Ahmed Abushamma, Aman Qureshi, Shelley Ivary, Adriano R Tonelli
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Abstract

Introduction: Portopulmonary hypertension (PoPH) occurs in roughly 5% of patients evaluated for liver transplant and increases perioperative morbidity and mortality. PoPH patients often succumb to complications of the underlying liver disease, therefore liver transplantation can be a lifesaving intervention. Medical treatment of PoPH optimizes patients for transplantation, but the knowledge on the effect of PH specific therapy on transplant eligibility is limited.

Evidence acquisition: We searched Medline, Embase, and Cochrane Library from inception to August 19, 2024. We aimed to include studies of adult patients with PoPH treated with pharmacologic therapies with comparison to placebo, baseline condition of the patient, or another medication. We only included studies where liver transplantation outcomes were reported.

Evidence synthesis: Out of 606 studies retrieved, 17, all observational cohorts, met inclusion criteria. None of the included studies had suitable control or comparison groups to assess medication efficacy in a pooled fashion. As a result, this systematic review aimed to describe the effect of PoPH treatments on transplant eligibility across studies and medication classes. A total of 812 patients received medical treatment, with 52% receiving liver transplant. Of studies reporting transplant eligibility, 65% of treated PoPH patients became transplant eligible.

Conclusions: Within the limitations of the available data, PoPH therapies improve transplant eligibility. Prospective studies, especially RCTs, are needed to better define the best treatment strategy in this population.

药物治疗对门脉性肺动脉高压患者肝移植资格的影响:一项系统综述。
导论:大约5%的肝移植评估患者发生门脉肺动脉高压(PoPH),并增加围手术期发病率和死亡率。PoPH患者经常死于潜在肝脏疾病的并发症,因此肝移植可以是一种挽救生命的干预措施。PoPH的医学治疗优化了移植患者,但关于PH特异性治疗对移植资格的影响的知识有限。证据获取:我们检索了Medline, Embase和Cochrane图书馆,从成立到2024年8月19日。我们的目标是纳入使用药物治疗的成人PoPH患者的研究,并与安慰剂、患者基线状况或其他药物进行比较。我们只纳入了报道了肝移植结果的研究。证据综合:在检索到的606项研究中,17项(所有观察性队列)符合纳入标准。纳入的研究均没有合适的对照组或对照组,以汇总方式评估药物疗效。因此,本系统综述旨在描述跨研究和药物类别的PoPH治疗对移植资格的影响。共有812例患者接受了治疗,其中52%接受了肝移植。在报告移植资格的研究中,65%接受治疗的PoPH患者符合移植资格。结论:在现有数据的限制下,PoPH疗法提高了移植资格。需要前瞻性研究,特别是随机对照试验,以更好地确定这一人群的最佳治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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