Temporal Trends in Portopulmonary Hypertension Model for End-stage Liver Disease Exceptions and Outcomes
Background. Model for end-stage liver disease (MELD) exception criteria for portopulmonary hypertension (POPH) were created to prioritize patients for liver transplant before POPH progression. Little is known about trends in POPH exception frequency, disease severity, pulmonary hypertension treatmen...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2022-12-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001410 |
| _version_ | 1797976870322438144 |
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| author | Kathryn T. del Valle, MD Michael J. Krowka, MD Julie K. Heimbach, MD Timucin Taner, MD, PhD Hilary M. DuBrock, MD |
| author_facet | Kathryn T. del Valle, MD Michael J. Krowka, MD Julie K. Heimbach, MD Timucin Taner, MD, PhD Hilary M. DuBrock, MD |
| author_sort | Kathryn T. del Valle, MD |
| collection | DOAJ |
| description | Background. Model for end-stage liver disease (MELD) exception criteria for portopulmonary hypertension (POPH) were created to prioritize patients for liver transplant before POPH progression. Little is known about trends in POPH exception frequency, disease severity, pulmonary hypertension treatment patterns, or outcomes since the POPH MELD exception began.
Methods. Using data from the Organ Procurement and Transplantation Network database, we describe the frequency of POPH MELD exceptions between 2006 and 2019, compare baseline patient characteristics, and characterize trends in liver disease and POPH severity‚ as well as POPH treatment and outcomes‚ over time. To facilitate comparison, we divided this 14-y period into 3 “eras” (2006–2010, 2011–2015, and 2016–2019).
Results. Between 2006 and 2019, 504 unique POPH MELD exceptions were granted. Both liver disease severity and patient age have increased over time (P = 0.04 and P = 0.006, respectively). Posttreatment hemodynamic values (mean pulmonary arterial pressure and pulmonary vascular resistance) have significantly improved (P < 0.001 and P = 0.008, respectively). Treatment with endothelin receptor antagonists has become more prevalent, whereas use of parenteral therapy and monotherapy regimens has decreased (P < 0.001). Neither waitlist nor liver transplant mortality outcomes have significantly changed over the eras analyzed.
Conclusions. In conclusion, 504 patients have received POPH MELD exceptions between 2006 and 2019. Since 2010, nearly all patients granted POPH MELD exceptions have met hemodynamic criteria for POPH. Over time, there has been a trend toward older age and higher MELD scores with significant changes in pulmonary arterial hypertension treatment patterns and an improvement in posttreatment hemodynamics without major change in outcomes. |
| first_indexed | 2024-04-11T04:57:51Z |
| format | Article |
| id | doaj.art-94bc6611fd83463c9cab2c2b1a1027db |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-04-11T04:57:51Z |
| publishDate | 2022-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-94bc6611fd83463c9cab2c2b1a1027db2022-12-26T06:08:11ZengWolters KluwerTransplantation Direct2373-87312022-12-01812e141010.1097/TXD.0000000000001410202212000-00009Temporal Trends in Portopulmonary Hypertension Model for End-stage Liver Disease Exceptions and OutcomesKathryn T. del Valle, MD0Michael J. Krowka, MD1Julie K. Heimbach, MD2Timucin Taner, MD, PhD3Hilary M. DuBrock, MD41 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.1 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.2 Division of Transplantation Surgery, Mayo Clinic, Rochester, MN.2 Division of Transplantation Surgery, Mayo Clinic, Rochester, MN.1 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.Background. Model for end-stage liver disease (MELD) exception criteria for portopulmonary hypertension (POPH) were created to prioritize patients for liver transplant before POPH progression. Little is known about trends in POPH exception frequency, disease severity, pulmonary hypertension treatment patterns, or outcomes since the POPH MELD exception began. Methods. Using data from the Organ Procurement and Transplantation Network database, we describe the frequency of POPH MELD exceptions between 2006 and 2019, compare baseline patient characteristics, and characterize trends in liver disease and POPH severity‚ as well as POPH treatment and outcomes‚ over time. To facilitate comparison, we divided this 14-y period into 3 “eras” (2006–2010, 2011–2015, and 2016–2019). Results. Between 2006 and 2019, 504 unique POPH MELD exceptions were granted. Both liver disease severity and patient age have increased over time (P = 0.04 and P = 0.006, respectively). Posttreatment hemodynamic values (mean pulmonary arterial pressure and pulmonary vascular resistance) have significantly improved (P < 0.001 and P = 0.008, respectively). Treatment with endothelin receptor antagonists has become more prevalent, whereas use of parenteral therapy and monotherapy regimens has decreased (P < 0.001). Neither waitlist nor liver transplant mortality outcomes have significantly changed over the eras analyzed. Conclusions. In conclusion, 504 patients have received POPH MELD exceptions between 2006 and 2019. Since 2010, nearly all patients granted POPH MELD exceptions have met hemodynamic criteria for POPH. Over time, there has been a trend toward older age and higher MELD scores with significant changes in pulmonary arterial hypertension treatment patterns and an improvement in posttreatment hemodynamics without major change in outcomes.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001410 |
| spellingShingle | Kathryn T. del Valle, MD Michael J. Krowka, MD Julie K. Heimbach, MD Timucin Taner, MD, PhD Hilary M. DuBrock, MD Temporal Trends in Portopulmonary Hypertension Model for End-stage Liver Disease Exceptions and Outcomes Transplantation Direct |
| title | Temporal Trends in Portopulmonary Hypertension Model for End-stage Liver Disease Exceptions and Outcomes |
| title_full | Temporal Trends in Portopulmonary Hypertension Model for End-stage Liver Disease Exceptions and Outcomes |
| title_fullStr | Temporal Trends in Portopulmonary Hypertension Model for End-stage Liver Disease Exceptions and Outcomes |
| title_full_unstemmed | Temporal Trends in Portopulmonary Hypertension Model for End-stage Liver Disease Exceptions and Outcomes |
| title_short | Temporal Trends in Portopulmonary Hypertension Model for End-stage Liver Disease Exceptions and Outcomes |
| title_sort | temporal trends in portopulmonary hypertension model for end stage liver disease exceptions and outcomes |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001410 |
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