title: Excellent outcome of living donor liver transplantation in patients with hepatopulmonary syndrome: a single centre experience.
abstract: BACKGROUND
  Hepatopulmonary syndrome (HPS) worsens the prognosis of cirrhosis and liver transplantation is only definitive treatment. There is paucity of data about role of living donor liver transplantation (LDLT) in HPS.
  
  
  METHODS
  Fourteen patients with HPS and cirrhosis who underwent LDLT were prospectively included. HPS was defined as PaO2 < 80 mmHg in presence of demonstrable macro-aggregated albumin (MAA) scan shunt fraction >6%.
  
  
  RESULTS
  The study group composed of 11 male and three female patients, mean age 50.3 ± 8.6 yr. Most common presentations were dyspnea (92.8%), cyanosis (78.5%) and clubbing (64.2%). Mean model for end-stage liver disease (MELD) score was 18.2 ± 4.7, mean MAA shunt fraction was 23.0 ± 13.2%, mean PaO2 was 58.7 ± 8.4 mmHg. Two patients had very severe HPS (PaO2 <50 mmHg), five had severe HPS (PaO2 >50 <60 mmHg) and seven had moderate HPS (PaO2 >60 <80 mmHg). All patients underwent right lobe LDLT. The overall time to extubation was 2 (1-32 days) and for hospital stay was 20 (17-46 days). The main complications in post-LT course were infection in 57% (cytomegalovirus or bacterial). All the patients are alive and off oxygen at a mean follow up of 29 ± 25 months.
  
  
  CONCLUSIONS
  We report one of the largest series of LDLT in HPS which has shown excellent results.
authors.affiliation: Medanta the Medicity, Institute of Liver Transplantation and Regenerative Medicine, Haryana, India. sanjivsaigal@hotmail.com
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Saigal
authors.forename: Narendra
authors.initials: N
authors.lastname: Choudhary
authors.forename: Neeraj
authors.initials: N
authors.lastname: Saraf
authors.forename: Hardik
authors.initials: H
authors.lastname: Kotecha
authors.forename: Rahul
authors.initials: R
authors.lastname: Kakodkar
authors.forename: Ravi
authors.initials: R
authors.lastname: Mohanka
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.forename: Palat
authors.initials: P
authors.lastname: Menon
authors.forename: Sanjay
authors.initials: S
authors.lastname: Goja
authors.forename: Deepak
authors.initials: D
authors.lastname: Govil
authors.forename: Vijay
authors.initials: V
authors.lastname: Vohra
authors.forename: Arvinder
authors.initials: A
authors.lastname: Soin
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D020065:Hepatopulmonary Syndrome / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index
keywords: cirrhosis; hepatopulmonary syndrome; liver transplantation; living donor liver transplantation; model for end-stage liver disease