Echocardiography-Detected Elevated Pulmonary Artery Systolic Pressure and Outcomes After Living Donor Liver Transplantation.

INTRODUCTION The clinical significance of mild to moderate elevation in pulmonary artery systolic pressure (PASP) detected by transthoracic echocardiography during liver transplant evaluation remains uncertain, particularly in living donor liver transplantation (LDLT).

Methods

A retrospective cohort study was conducted of adult living donor liver transplant recipients between 2018 and 2023. Preoperative PASP was estimated using transthoracic echocardiography, and patients were stratified into PASP ≤35 mm Hg and elevated PASP (>35 mm Hg) groups. The primary outcome was 5-year overall survival, and the secondary outcome was intensive care unit (ICU) stay.

Results

Among 230 recipients, 141 had PASP ≤35 mm Hg and 89 had PASP >35 mm Hg. Five-year overall survival was similar between groups (70%vs 72%; log-rank p = 0.905). Elevated PASP was not associated with mortality on univariate Cox regression analysis. The proportion of patients with prolonged ICU stay (>5 days) did not differ significantly between groups. Higher body mass index was identified as a significant predictor of increased mortality risk.

Conclusion

Mild to moderate PASP elevation detected by echocardiography was not associated with inferior long-term survival or increased ICU utilization following LDLT. Modest PASP elevation on preoperative echocardiography alone should not preclude transplantation in carefully selected candidates.