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Purpose <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月18日

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  • Burak Yagdiran,
  • Batuhan Kirisci,
  • Nedim Cekmen,
  • Ahmed Uslu,
  • Mehmet Haberal

摘要

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.