For post-LT patients who improve on PAH therapy, what objective criteria do you require before attempting medication withdrawal, and how do you structure a safe de-escalation plan?

At month 4 post-liver transplant, we routinely repeat a transthoracic echocardiogram to look at the right size and right ventricular function parameters and compare to pre-transplant echoes.

We focus on reducing/discontinuing IV prostacyclin medications 1st.

The final decision to stop IV prostacycli...