Treatment of pulmonary hypertension with inhaled nitric oxide during orthotopic liver transplantation
Bibliographic record
Abstract
Despite pre-transplant screening, patients with chronic liver disease may present with previously undiagnosed pulmonary hypertension (PH) at the time of liver transplantation. While severe portopulmonary hypertension (PoPH) at the time of surgery is considered a contraindication to transplantation, the current evidence guiding perioperative management of newly diagnosed PH is limited. We present a case of a 65-year-old male with previously undiagnosed severe PH secondary to cirrhosis-related hyperdynamic circulation, successfully managed with intra- and postoperative inhaled nitric oxide (iNO) therapy during orthotopic liver transplantation. Rapid stabilization of elevated mean pulmonary pressures (mPAP) allowed an uncomplicated perioperative transplant course. This case highlights the importance of recognizing and addressing newly diagnosed PH at the time of liver transplantation. Whereas severe PoPH presents significant perioperative risk, PH in cirrhosis is more commonly due to alternative etiologies of venous congestion or hyperdynamic circulation. Our case suggests that elevated mPAP of alternative etiologies may not immediately compromise postoperative transplant outcomes. Intraoperative vasodilator therapy, including iNO, may be a useful therapeutic and diagnostic tool in these cases. Further investigation into perioperative management of new PH in liver transplantation is warranted to refine surgical decision-making and improve patient outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".