Liver transplantation for hepatopulmonary syndrome: a ten-year experience in Paris, France.
BACKGROUND
Although the possibility of reversing hepatopulmonary syndrome (HPS) after liver transplantation is now well established, the proportion of patients in whom reversibility is observed and the time to resolution of HPS remain uncertain.


METHODS
We analyzed the outcome of all adult patients with HPS who underwent orthotopic liver transplantation in all the liver transplant centers in Paris, during a 10-year period.


RESULTS
Twenty-three adult patients (median age, 47 years; range, 14-64) underwent transplantation in four institutions. Median PaO(2) was 52 (range, 32-67) mm Hg and median alveolar-arterial oxygen gradient was 66 mm Hg. When patients were breathing 100% O(2), median PaO(2) was 310 (range, 74-663) mm Hg. Median isotopic shunt ratio was 33% (range, 0-80%). The overall mortality during the study period was 30.5% (7/23). Perioperative mortality was 8.5%, whereas late mortality was 22%. None of the preoperative characteristics of HPS (isotopic shunt ratio, PaO(2) on room air or on 100% oxygen) was associated with overall postoperative mortality. Of the 21 patients surviving the perioperative period (median follow-up, 17 months; range, 0.5-72), a decrease in alveolar-arterial oxygen gradient of at least 5 mm Hg and at least 10 mm Hg was observed in 21 of 21 and in 18 of 21 patients, respectively, with great variations in the time of improvement. The threshold of 70 mm Hg was reached in 15 patients. The lower the preoperative PaO(2), the longer the time to reach this point.


CONCLUSIONS
Our data strongly support the role of orthotopic liver transplantation in adult patients with HPS, regardless of its severity.
Taillé
Camille
C
Service de Pneumologie et de Reéanimation Respiratoire et INSERM U408, Service d'Hepatologie, Service de Chirurgie Digestive, Hôpital Beaujon, Clichy, France.
Cadranel
Jacques
J
Bellocq
Agnès
A
Thabut
Gabriel
G
Soubrane
Olivier
O
Durand
François
F
Ichaï
Philippe
P
Duvoux
Christophe
C
Belghiti
Jacques
J
Calmus
Yvon
Y
Mal
Hervé
H
D000293:Adolescent; D000328:Adult; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012189:Retrospective Studies
D010100:Oxygen