What question did this study set out to answer?

This study aims to determine the influence of pre-transplant pulmonary hypertension on liver graft perfusion and rejection.

May 21, 2026Open Access

The relationship between pulmonary hypertension and graft vascular resistance and rejection in liver transplant patients

BYBurak YağdıranBaşkent University BKBatuhan KirisciBaşkent University NCNedim CekmenBaşkent University

Key Points

This study aims to determine the influence of pre-transplant pulmonary hypertension on liver graft perfusion and rejection.
Retrospective cohort of 283 liver transplant patients
Assessed pulmonary hypertension risk via transthoracic echocardiography
Measured hepatic artery resistive index and peak systolic velocity using Doppler ultrasound during follow-up.
Resistive index significantly varied among pulmonary hypertension risk groups in the early postoperative period.
No independent association between pre-transplant pulmonary hypertension risk and peak systolic velocity after adjustments.
No significant link between pulmonary hypertension risk and graft rejection was found.

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.

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