[Prevalence and risk factors of significant intrapulmonary shunt in cirrhotic patients awaiting liver transplantation].
OBJECTIVE
Hepatopulmonary syndrome is a condition of severe hypoxia with intrapulmonary shunt (IPS) in the setting of hepatic dysfunction. Liver transplantation has been suggested as a definite treatment for hepatopulmonary syndrome with reversal of IPS in some patients. Inconsistency of response and inability to predict reversibility, however, are significant problems. We performed this study to evaluate the prevalence of significant IPS in pretransplantation cirrhotic patients and to find any risk factors of IPS.


METHODS
Fifty-seven patients (M:F = 38:19, median age 49 years (range 18-71)) with liver cirrhosis awaiting liver transplantation were serially included. Their IPS status was evaluated using contrast- enhanced echocardiography. Significant shunt was defined as a shunt of grade >or= 2.


RESULTS
Significant IPS was detected in 30 (52.6%) among 57 patients. Significant shunt was found in 24 (63.2%) of 38 Child-Pugh class C patients and in 6 (31.6%) of 19 Child-Pugh class A or B patients (p < 0.05). No significant difference in prevalence of significant shunt was seen according to age, sex, presence or absence of hepatocellular carcinoma, ascites, hepatic encephalopathy, and gastroesophageal varix.


CONCLUSIONS
Significant intrapulmonary shunt is a common finding in cirrhotic patients awaiting liver transplantation. Child-Pugh class C is the risk factor associated with high prevalence of significant shunt.
Lee
Ji Min
JM
Division of Gastroenterology and Gastrointestinal Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Choi
Moon Seok
MS
Lee
Sang Chol
SC
Park
Seung Woo
SW
Bae
Mun Hee
MH
Lee
Joon Hyeok
JH
Koh
Kwang Cheol
KC
Paik
Seung Woon
SW
Rhee
Poong Lyul
PL
Kim
Jae Jun
JJ
Rhee
Jong Chul
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation; D012307:Risk Factors