Ghosh, Souvik

Abstract Rationale Pulmonary artery pulsatility index (PAPi) is defined as pulmonary artery pulse pressure divided by right atrial pressure and has been identified as a predictor of mortality in pulmonary hypertension. Portopulmonary-hypertension (POPH), a subset associated with portal hypertension, lacks a clear prognostic association with PAPi. This study aimed to assess whether perioperative PAPi values correlate with outcomes in liver transplant patients with POPH. Methods This single-center, retrospective study included POPH patients undergoing liver transplantation at Mayo Clinic Florida from June 2003 to December 2023. 69 patients were categorized based on the lower PAPi quartile in our dataset (>0.9 or ≤ 0.9), measured via catheterization within one day of transplantation, comparing baseline characteristics and outcomes. Categorical variables were analyzed using chi-square or Fisher's exact tests, while continuous variables were compared with independent t-tests or Mann-Whitney U tests. Unadjusted and adjusted odds ratios (ORs) for 1-year mortality were calculated using logistic regression for baseline comorbidities and univariate significance. Results Most patients were white (91.3%) and non-Hispanic (82.6%), with a mean BMI of 29.3 kg/m² and MELD score of 20.3. Mean hemodynamic data included heart rate of 75.8 bpm, pulmonary artery pressure of 29.9 mmHg, right atrial pressure of 15.1 mmHg, and PAPi of 1.25. Mortality rates were 7.2% at 30 days, 10.1% at 90 days, and 11.6% at 1 year. Patients with PAPi >0.9 (n=50) were older (mean age 58.2 vs. 52.9) than those with PAPi ≤0.9 (n=19). The PAPi >0.9 group was predominantly white (94% vs. 84.2%, p=0.04), with no significant differences in BMI, MELD scores, or ethnicity. Mortality at 30 and 90 days was higher in the PAPi >0.9 group (10% and 14%, respectively) compared to the PAPi ≤0.9 group (0% for both); however, differences were not statistically significant. At 1 year, mortality was 14% in the PAPi >0.9 group and 5.3% in the PAPi ≤0.9 group, with no statistical significance. Multivariate analysis indicated no association between PAPi and 1-year mortality (OR 0.12-0.24, p=0.2-0.3), and PAPi as a continuous variable showed no link with 1-year mortality. Conclusions PAPi was not significantly associated with 1-year mortality in liver transplant patients with POPH, suggesting that it should not be used alone to decide listing for transplantation. Further studies with larger cohorts are needed to confirm these findings or identify alternative hemodynamic markers or PAPi values predictive of long-term outcomes in this high-risk group.