Performance of echocardiography for detection of portopulmonary hypertension among liver transplant candidates: Meta-analysis

Parker M. Korbitz, John P. Gallagher, Hrishikesh Samant, Shailender Singh, Loretta Jophlin, Thammasin Ingviya, Wuttiporn Manatsathit

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Evaluation of pulmonary arterial pressure is crucial among cirrhotic patients, considering that moderate portopulmonary hypertension (POPH) is a contraindication for liver transplantation. Although right heart catheterization (RHC) is the most accurate method to diagnose POPH, it is invasive. Objective: The aim of the study is to evaluate the performance of echocardiography in detecting POPH in liver transplant candidates. Methods: A Literature search was performed, and pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, and area under the summary receiver operating curve (AUC) were calculated. Subgroup analyses were performed based on different cutoff values for echocardiography and diagnostic criteria of RHC. Results: Sensitivity, specificity, positive LR, negative LR, and AUC of echocardiography for detection of POPH were 0.86 (0.74, 0.94), 0.87 (0.84, 0.90), 7.17 (3.59, 14.31), 0.22 (0.13, 0.38), and 0.807 while they were 0.82 (0.74, 0.89), 0.81 (0.78, 0.84), 117.75 (16.03, 865.08), 0.28 (0.16, 0.50), and 0.876for detection of moderate POPH, respectively. Performance of echocardiography was not significantly different in the subgroup analyses of stringency of POPH criteria and pulmonary arterial systolic pressure (ePASP) cutoffs. Conclusions: Our meta-analysis supports utilization of echocardiography for screening of POPH. However, RHC remains essential in highly suspicious cases. Echocardiographic data other than ePASP should be evaluated in future studies.

Original languageEnglish (US)
Article numbere13995
JournalClinical Transplantation
Issue number11
StatePublished - Nov 2020


  • cirrhosis
  • echocardiography
  • liver transplantation
  • portal hypertension
  • portopulmonary hypertension
  • right heart catheterization

ASJC Scopus subject areas

  • Transplantation


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