Prognostic Importance of Increased Right Ventricular Afterload in Orthotopic Liver Transplantation Recipients with Endstage Cirrhosis

Background Severely increased right ventricular (RV) afterload is considered a contra-indication for orthotopic liver transplantation (OLT). This study assesses the effects of mildly increased RV afterload on long-term outcome after OLT in relation to RV function. Methods 139 OLT recipients (53 ± 12 years, 76% male) were included. Preoperative RV afterload was assessed invasively or, if not available, echocardiographically and categorised as normal, high-normal (mean pulmonary artery pressure [PAP] 20–25 mmHg or echocardiographic systolic PAP 35–40 mmHg) or mildly elevated (mean PAP 25–35 mmHg or systolic PAP 40–50 mmHg). The association between level of RV afterload, echocardiographic RV function and postoperative outcome was assessed. Results Right ventricular afterload was high-normal in 17% and mildly elevated in 12% of patients. Patients with elevated RV afterload had higher echocardiographic RV dimensions and left ventricular filling pressures. RV functional parameters were within normal range and not associated with RV afterload. Increased RV afterload was associated with a higher incidence of postoperative haemodynamic complications (8%, 17%, and 29% for normal, high-normal and mildly elevated RV afterload, respectively, p = 0.03) and worse survival (8-year survival 74%, 41% and 37% respectively, p = 0.01). Preoperative RV function was not associated with outcome after OLT. Conclusions Increased RV afterload was associated with increased haemodynamic complications and worse long-term survival in OLT recipients. Right ventricular function in patients with increased RV afterload was within normal range and not associated with postoperative outcome.