title: Hepatopulmonary syndrome and portopulmonary hypertension: a report of the multicenter liver transplant database.
abstract: Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PortoPH) are pulmonary vascular consequences of advanced liver disease associated with significant mortality after orthotopic liver transplantation (OLT). Data from 10 liver transplant centers were collected from 1996 to 2001 that characterized the outcome of patients with either HPS (n = 40) or PortoPH (n = 66) referred for OLT. Key variables (PaO2 for HPS, mean pulmonary artery pressure [MPAP], pulmonary vascular resistance [PVR], and cardiac output [CO] for PortoPH) were analyzed with respect to 3 definitive outcomes (those denied OLT, transplant hospitalization survivors, and transplant hospitalization nonsurvivors). OLT was denied in 8 of 40 patients (20%) with HPS and 30 of 66 patients (45%) with PortoPH. Patients with HPS who were denied OLT had significantly worse PaO2 compared with patients who underwent transplantation (47 vs. 52 mm Hg, P <.005). Transplant hospitalization survival was associated with higher pre-OLT PaO2 (55 vs. 37 mm Hg; P <.005). MPAP was significantly higher (53 vs. 45 mm Hg; P <.015) and PVR was significantly worse (614 vs. 335 dynes. s. cm(-5); P <.05) in patients with PortoPH who were denied OLT compared with patients who underwent transplantation. Transplant hospitalization mortality was 16% (5/32) in patients with HPS and 36% (13/36) in patients with PortoPH. All of the deaths in patients with PortoPH occurred within 18 days of OLT; 5 of the 13 deaths in patients with PortoPH occurred intraoperatively. We concluded that patients with HPS (based on a combination of low PaO2 and nonpulmonary factors) and patients with PortoPH (based on pulmonary hemodynamics) were frequently denied OLT because of pre-OLT test results and comorbidities. For patients who subsequently underwent OLT, transplant hospitalization mortality remained significant for both those with HPS (16%) and PortoPH (36%).
authors.affiliation: Mayo Clinic, Rochester, Minnesota 55905, USA. krowka@mayo.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Krowka
authors.forename: M Susan
authors.initials: MS
authors.lastname: Mandell
authors.forename: Michael A E
authors.initials: MA
authors.lastname: Ramsay
authors.forename: Steve M
authors.initials: SM
authors.lastname: Kawut
authors.forename: Michael B
authors.initials: MB
authors.lastname: Fallon
authors.forename: Cosme
authors.initials: C
authors.lastname: Manzarbeitia
authors.forename: Manuel
authors.initials: M
authors.lastname: Pardo
authors.forename: Paul
authors.initials: P
authors.lastname: Marotta
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.forename: Markus P
authors.initials: MP
authors.lastname: Stoffel
authors.forename: Joanne T
authors.initials: JT
authors.lastname: Benson
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries; D016208:Databases, Factual; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000150:complications* / Q000601:surgery*; D006976:Hypertension, Pulmonary / Q000097:blood / Q000150:complications*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D016079:Refusal to Treat; D040841:Resource Allocation
chemical_list: D010100:Oxygen