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.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada. guptas@smh.toronto.on.ca
S
S
Gupta
H
H
Castel
R V
RV
Rao
M
M
Picard
L
L
Lilly
M E
ME
Faughnan
G
G
Pomier-Layrargues
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