title: Prevalence and severity of hepatopulmonary syndrome and its influence on survival in cirrhotic patients evaluated for liver transplantation.
abstract: The prevalence of hepatopulmonary syndrome (HPS) and its influence on survival before and after liver transplantation (LT) remain controversial. Additionally, the chronology of post-LT reversibility is unclear. This study prospectively analyzed 316 patients with cirrhosis who were evaluated for LT in 2002-2007; 177 underwent LT at a single reference hospital. HPS was defined by a partial pressure of arterial oxygen (PaO2 ) <70 mmHg and/or an alveolar-arterial oxygen gradient (A-a PO2 ) ≥20 mmHg in the supine position and positive contrast echocardiography. The prevalence of HPS was 25.6% (81/316 patients), and most patients (92.6%) had mild or moderate HPS. High Child-Pugh scores and the presence of ascites were independently associated with HPS. Patients with and without HPS did not significantly differ in LT waiting list survival (mean 34.6 months vs. 41.6 months, respectively; log-rank, p = 0.13) or post-LT survival (mean 45 months vs. 47.6 months, respectively; log-rank, p = 0.62). HPS was reversed in all cases within 1 year after LT. One-fourth of the patients with cirrhosis who were evaluated for LT had HPS (mostly mild to moderate); the presence of HPS did not affect LT waiting list survival. HPS was always reversed after LT, and patient prognosis did not worsen.
authors.affiliation: Digestive Diseases Department, Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Pascasio
authors.forename: I
authors.initials: I
authors.lastname: Grilo
authors.forename: F J
authors.initials: FJ
authors.lastname: López-Pardo
authors.forename: F
authors.initials: F
authors.lastname: Ortega-Ruiz
authors.forename: J L
authors.initials: JL
authors.lastname: Tirado
authors.forename: J M
authors.initials: JM
authors.lastname: Sousa
authors.forename: M J
authors.initials: MJ
authors.lastname: Rodriguez-Puras
authors.forename: M T
authors.initials: MT
authors.lastname: Ferrer
authors.forename: M
authors.initials: M
authors.lastname: Sayago
authors.forename: M A
authors.initials: MA
authors.lastname: Gómez-Bravo
authors.forename: A
authors.initials: A
authors.lastname: Grilo
mesh_terms: D005260:Female; D020065:Hepatopulmonary Syndrome / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012720:Severity of Illness Index; D016019:Survival Analysis; D014850:Waiting Lists
keywords: Ascites; echocardiography; portal hypertension; pulmonary vascular diseases and perioperative care