title: Sustained low diffusing capacity in hepatopulmonary syndrome after liver transplantation.
abstract: OBJECTIVE
  To study the presence of sustained low diffusing capacity (DL(CO)) after liver transplantation (LT) in patients with hepatopulmonary syndrome (HPS).
  
  
  METHODS
  Six patients with mild-to-severe HPS and 24 without HPS who underwent LT were prospectively followed before and after LT at mid-term (median, 15 mo). HPS patients were also assessed at long-tem (median, 86 mo).
  
  
  RESULTS
  Before LT, HPS patients showed lower PaO(2) (71 +/- 8 mmHg), higher AaPO(2) (43 +/- 10 mmHg) and lower DL(CO) (54% +/- 9% predicted), due to a combination of moderate-to-severe ventilation-perfusion (V(A)/Q) imbalance, mild shunt and diffusion limitation, than non-HPS patients (94 +/- 4 mmHg and 19 +/- 3 mmHg, and 85% +/- 3% predicted, respectively) (P<0.05 each). Seven non-HPS patients had also reduced DL(CO) (70% +/- 4% predicted). At mid- and long-term after LT, compared to pre-LT, HPS patients normalized PaO(2) (91 +/- 3 mmHg and 87 +/- 5 mmHg), AaPO(2) (14 +/- 3 mmHg and 23 +/- 5 mmHg) and all V(A)/Q descriptors (P<0.05 each) without changes in DL(CO) (53% +/- 8% and 56% +/- 7% predicted, respectively). Post-LT DL(CO) in non-HPS patients with pre-LT low DL(CO) was unchanged (75% +/- 6% predicted).
  
  
  CONCLUSIONS
  While complete V(A)/Q resolution in HPS indicates a reversible functional disturbance, sustained low DL(CO) after LT also present in some non-HPS patients, points to persistence of sub-clinical liver-induced pulmonary vascular changes.
authors.affiliation: Servei de Pneumologia, Hospital Clinic, Villarroel, 170. 08036-Barcelona, Spain.
authors.forename: Graciela
authors.initials: G
authors.lastname: Martínez-Palli
authors.forename: Federico P
authors.initials: FP
authors.lastname: Gómez
authors.forename: Joan A
authors.initials: JA
authors.lastname: Barberà
authors.forename: Miquel
authors.initials: M
authors.lastname: Navasa
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
authors.forename: Robert
authors.initials: R
authors.lastname: Rodríguez-Roisin
authors.forename: Felip
authors.initials: F
authors.lastname: Burgos
authors.forename: Conchi
authors.initials: C
authors.lastname: Gistau
mesh_terms: D000328:Adult; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology*; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011653:Pulmonary Diffusing Capacity / Q000502:physiology*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D014692:Ventilation-Perfusion Ratio / Q000502:physiology