Improved survival after liver transplantation in patients with hepatopulmonary syndrome.
Hepatopulmonary syndrome (HPS) is present in 10-32% of chronic liver disease patients, carries a poor prognosis and is treatable by liver transplantation (LT). Previous reports have shown high LT mortality in HPS and severe HPS (arterial oxygen (PaO(2)) < or =50 mmHg). We reviewed outcomes in HPS patients who received LT between 2002 and 2008 at two transplant centers supported by a dedicated HPS clinic. We assessed mortality, complications and gas exchange in 21 HPS patients (mean age 51 years, MELD score 14), including 11/21 (52%) with severe HPS and 5/21 (24%) with living donor LT (median follow-up 20.2 months after LT). Overall mortality was 1/21 (5%); mortality in severe HPS was 1/11 (9%). Peritransplant hypoxemic respiratory failure occurred in 5/21 (24%), biliary complications in 8/21 (38%) and bleeding or vascular complications in 6/21 (29%). Oxygenation improved in all 19 patients in whom PaO(2) or SaO(2) were recorded. PaO(2) increased from 52.2 +/- 13.2 to 90.3 +/- 11.5 mmHg (room air) (p < 0.0001) (12 patients); a higher baseline macroaggregated albumin shunt fraction predicted a lower rate of postoperative improvement (p = 0.045) (7 patients). Liver transplant survival in HPS and severe HPS was higher than previously demonstrated. Severity of HPS should not be the basis for transplant refusal.
Gupta
S
S
Department of Medicine, University of Toronto, Toronto, Ontario, Canada. guptas@smh.toronto.on.ca
Castel
H
H
Rao
R V
RV
Picard
M
M
Lilly
L
L
Faughnan
M E
ME
Pomier-Layrargues
G
G
D000328:Adult; D020065:Hepatopulmonary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008875:Middle Aged; D010100:Oxygen; D010102:Oxygen Inhalation Therapy / Q000401:mortality; D011184:Postoperative Period; D016896:Treatment Outcome
D010100:Oxygen