Burak Yagdiran, Batuhan Kirisci, Nedim Cekmen, Ahmed Uslu, Mehmet Haberal
Baskent University Medical Center.
Turkey
BioMedical Central Pulmonary Medicine
BMC Pulm Med 2026;
DOI: 10.1186/s12890-026-04351-7
Abstract
Purpose: Pulmonary hypertension (PH) is associated with systemic hemodynamic changes that may influence graft perfusion following liver transplantation (LT). In this study, we aimed to evaluate whether pre-transplant PH risk, as estimated by transthoracic echocardiography (TTE), is associated with early post-transplant hepatic artery Doppler parameters, including resistive index (RI) and peak systolic velocity (PSV). We also sought to assess whether echocardiography-derived PH risk is associated with biopsy-proven graft rejection.
Methods: In this retrospective cohort study, 283 patients who underwent LT were included. Patients were stratified based on TTE-derived systolic pulmonary artery pressure (sPAP). Hepatic artery RI and PSV were measured using Doppler ultrasound (US) at predefined postoperative time points. Longitudinal changes were analyzed using generalized estimating equation models, and graft rejection was assessed based on biopsy findings during follow-up.
Results: RI values differed across PH risk groups, particularly in the early postoperative period. Longitudinal analysis showed a significant effect of time and a significant interaction between PH risk and time, while the overall effect of PH risk approached significance after adjustment for covariates. PSV values also varied over time; however, no independent association between PH risk and PSV was observed after adjustment for age and sex. Subgroup analysis indicated that both RI and PSV values were significantly higher in adult compared to pediatric patients. No statistically significant association was found between PH risk and biopsy-proven graft rejection.
Conclusion: Pre-transplant TTE-derived PH risk may influence postoperative hepatic artery Doppler parameters, particularly RI in the early postoperative period. However, its association with graft rejection remains unclear and should be interpreted with caution. Further prospective studies with larger patient cohorts are needed to clarify these relationships better.
Category
Class I. Pulmonary Hypertension Associated with Liver Disease
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Age Focus: Pediatric Pulmonary Vascular Disease or Adult Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes