• Alexandre Joosten, François Martin Carrier, Aïmane Menioui, Philippe Van der Linden, Brenton Alexander, Audrey Coilly, Nicolas Golse, Marc-Antoine Allard, Valerio Lucidi, Daniel Azoulay, Salima Naili, Leila Toubal, Maya Moussa, Lydia Karam, Hung Pham, Edita Laukaityte, Youcef Amara, Marc Lanteri-Minet, Didier Samuel, Olivier Sitbon, Marc Humbert, Laurent Savale, and Jacques Duranteau.
• Department of Anesthesiology and Intensive Care, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France. joosten-alexandre@hotmail.com.
• BMC Anesthesiol. 2022 Sep 21; 22 (1): 300.

BackgroundIn patients with end stage liver disease (ESLD) scheduled for liver transplantation (LT), an intraoperative incidental finding of elevated mean pulmonary arterial pressure (mPAP) may be observed. Its association with patient outcome has not been evaluated. We aimed to estimate the effects of an incidental finding of a mPAP > 20 mmHg during LT on the incidence of pulmonary complications.MethodsWe examined all patients who underwent a LT at Paul-Brousse hospital between January 1,2015 and December 31,2020. Those who received: a LT due to acute liver failure, a combined transplantation, or a retransplantation were excluded, as well as patients for whom known porto-pulmonary hypertension was treated before the LT or patients who underwent a LT for other etiologies than ESLD. Using right sided pulmonary artery catheterization measurements made following anesthesia induction, the study cohort was divided into two groups using a mPAP cutoff of 20 mmHg. The primary outcome was a composite of pulmonary complications. Univariate and multivariable logistic regression analyses were performed to identify variables associated with the primary outcome. Sensitivity analyses of multivariable models were also conducted with other mPAP cutoffs (mPAP ≥ 25 mmHg and ≥ 35 mmHg) and even with mPAP as a continuous variable.ResultsOf 942 patients who underwent a LT, 659 met our inclusion criteria. Among them, 446 patients (67.7%) presented with an elevated mPAP (mPAP of 26.4 ± 5.9 mmHg). When adjusted for confounding factors, an elevated mPAP was not associated with a higher risk of pulmonary complications (adjusted OR: 1.16; 95%CI 0.8-1.7), nor with 90 days-mortality or any other complications. In our sensitivity analyses, we observed a lower prevalence of elevated mPAP when increasing thresholds (235 patients (35.7%) had an elevated mPAP when defined as ≥ 25 mmHg and 41 patients (6.2%) had an elevated mPAP when defined as ≥ 35 mmHg). We did not observe consistent association between a mPAP ≥ 25 mmHg or a mPAP ≥ 35 mmHg and our outcomes.ConclusionIncidental finding of elevated mPAP was highly prevalent during LT, but it was not associated with a higher risk of postoperative complications.© 2022. The Author(s).

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