Introduction: Screening of portopulmonary hypertension (PoPH) is recommended in all patients referred for liver transplantation (LT) because of its major impact on management and outcomes.

Aims: To investigate the impact of the new definition of precapillary pulmonary hypertension (PH) according to the 2022 ESC/ERS guidelines on the prevalence of PoPH in LT candidates.

Methods: Right heart catheterization was performed in 231 consecutive patients referred for LT and enrolled in the prospective multicentric LungOLT study. Prevalence of pre and postcapillary PH was investigated according to the definition of 2015 and 2022 ESC/ERS guidelines respectively.

Results: The mean age was 53±8 years [78% males, 73% Child-Pugh (CP) stage B or C]. Twenty-one (9.4%) had a mean pulmonary artery pressure (mPAP)?25 mmHg with a pulmonary arterial wedge pressure (PAWP) >15 mmHg in 10 (4.3%) patients and a PAWP?15 mmHg in 11 (4.7%) patients. Among patients with a PAWP?15 mmHg, 4 (1.7%) patients had pulmonary vascular resistance (PVR) >3WU. Considering the new definition of PH, 55 (24%) had a mPAP>20 mmHg with a PAWP>15 mmHg in 22 (9.5%) and a PAWP?15 mmHg in 33 (14%) patients. Among patients with a PAWP?15 mmHg, 13 (5.6%) patients had PVR>2WU. None of the patients with a mPAP between 21 and 25 mmHg had a PVR>3 WU.

Conclusion: In this large cohort of cirrhotic patients referred for liver transplantation, the new definition of precapillary PH had a significant impact on the prevalence of PoPH increasing from 1.7 to 5.3%.