title: Impact of hepatopulmonary syndrome on quality of life and survival in liver transplant candidates.
abstract: OBJECTIVE
  Hepatopulmonary syndrome (HPS) affects 10%-30% of patients with cirrhosis and portal hypertension, but the impact on functional status, quality of life, and survival is poorly defined. We assessed the impact of HPS in patients evaluated for liver transplantation.
  
  
  METHODS
  We performed a prospective multicenter cohort study of patients being evaluated for liver transplantation in 7 academic centers in the United States. Patients with HPS (defined as an increased alveolar-arterial oxygen gradient with intrapulmonary vasodilation) were compared with those without HPS in terms of demographics and clinical variables. New York Heart Association functional class, quality of life, and survival were assessed.
  
  
  RESULTS
  Seventy-two patients with HPS and 146 patients without HPS were compared. There were no differences in age, sex, or etiology or severity of liver disease between the groups; however, patients with HPS were less likely to have a history of smoking (P = .03). Patients with HPS had worse New York Heart Association functional class (P = .005) and had significantly worse quality of life in certain domains compared with patients without HPS. In addition, patients with HPS also had a significantly increased risk of death compared with patients without HPS despite adjustment for age, sex, race/ethnicity, Model for End-Stage Liver Disease score, and liver transplantation (adjusted hazard ratio = 2.41; 95% confidence interval, 1.31-4.41; P = .005).
  
  
  CONCLUSIONS
  HPS was associated with a significant increase in risk of death as well as worse functional status and quality of life in patients evaluated for liver transplantation.
authors.affiliation: Department of Medicine, University of Alabama, Birmingham, Alabama 35294-0005, USA. mfallon@uab.edu
authors.forename: Michael B
authors.initials: MB
authors.lastname: Fallon
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Krowka
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.forename: James F
authors.initials: JF
authors.lastname: Trotter
authors.forename: Steven
authors.initials: S
authors.lastname: Zacks
authors.forename: Kari E
authors.initials: KE
authors.lastname: Roberts
authors.forename: Vijay H
authors.initials: VH
authors.lastname: Shah
authors.forename: Neil
authors.initials: N
authors.lastname: Kaplowitz
authors.forename: Lisa
authors.initials: L
authors.lastname: Forman
authors.forename: Keith
authors.initials: K
authors.lastname: Wille
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kawut
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000401:mortality / Q000523:psychology / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000401:mortality / Q000523:psychology / Q000601:surgery; D017093:Liver Failure / Q000401:mortality / Q000523:psychology / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000523:psychology; D011300:Preoperative Care; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index