Lung vascular disorders in liver transplant tertiary referral centers in Mexico.

We have read with interest the recent original contributions published in your journal regarding the experience of liver transplantation (LT) in some of the most important tertiary referrals centers in Mexico.1-4 We would like to share some thoughts and concerns regarding the importance of the development of lung vascular disorders in the setting of liver disease/portal hypertension, since those disorders have been documented in the forms of portopulmonary hypertension (POPH) and hepatopulmonary syndrome (HPS),5 carrying significant morbidity and mortality, particularly in the perioperative setting of LT. Recent prospective studies have estimated the prevalence of POPH and HPS of 8.5% and 10-30%, respectively, especially in tertiary centers evaluating LT candidates.5,6 We found that in one of the 55 patients transplanted in the San Jose Tec de Monterrey died in the postoperative day 2 from pulmonary hypertension (PH).1 Also, interestingly, the UMAE 25 IMSS, they mentioned also among the cardiovascular complications and comorbidities of their patients the presence of tricuspid regurgitation in two of their candidates.3 This particular echocardiographic parameters estimates the right ventricular systolic pressures (RVSP), nowadays being consider a fundamental component in the screening for the diagnosis of and PH,7 and also for POPH in the pretransplant period, with the subsequent decision to perform right heart catheterization (RHC) in LT candidates. Based on this, we would like to share the following concerns/questions: