Abstract Rationale Portopulmonary hypertension (PoPH) is a serious pulmonary vascular complication of portal hypertension with high mortality and limited eligibility for liver transplantation (LT). The combination of pulmonary arterial hypertension (PAH)-targeted therapy and inclusion of PoPH in the Model for End-Stage Liver Disease (MELD) exception score system has broadened LT eligibility for patients with PoPH and significantly improved the survival for those who undergo LT. However, the survival benefit of achieving hemodynamic criteria for MELD exception in patients who are otherwise ineligible for LT remains undefined. The primary objective was to compare overall survival in patients who met hemodynamic criteria for MELD exception versus those who did not. The secondary objective was to identify independent reasons for LT ineligibility. Methods A retrospective study analyzed patients with PoPH using a single center database from 2000 to 2024. Demographic data, functional class, right heart catheterization, and echocardiographic parameters were collected at the time of PoPH diagnosis. Patients were followed from the date of PoPH diagnosis until death or last encounter. Overall survival was estimated using the Kaplan-Meier (KM) method and compared via the log-rank test. Continuous data were analyzed with Student’s t-tests or Wilcoxon rank-sum tests, and categorical data with chi-square or Fisher’s exact tests, with p 0.05 considered significant. Results Of the 57 patients, 88% (50/57) presented with pulmonary hemodynamic that precluded LT listing. Following PAH therapy, 96% (55/57) showed significant improvements in mean pulmonary arterial pressure (p0.001), pulmonary vascular resistance (p0.001), and cardiac index (p=0.002). Only 37% (21/57) met hemodynamic criteria for MELD exception. KM survival analysis demonstrated no significant difference in survival between patients who achieved the hemodynamic criteria for MELD exception and those who did not (p = 0.56), despite comparable MELD scores and age between these groups. Patients who underwent LT combined with PAH therapy had better survival compared to those receiving PAH therapy alone or without PAH therapy (p0.001). Failure to meet the MELD exception score was main reason for LT ineligibility, though this was rarely the sole factor; other comorbid conditions, well-compensated liver disease and patient-specific factors also contributed. Conclusion While PAH-targeted therapy improves PoPH hemodynamics and facilitates access to LT through MELD exception scores, achieving MELD exception status alone does not confer a survival advantage without LT. Patient who fail to meet the MELD exception criteria often have additional contraindications that are independent barriers to LT listing. This abstract is funded by: none
Lai et al. (Fri,) studied this question.