title: Hepatopulmonary syndrome associated with nodular regenerative hyperplasia after liver transplantation in a child.
abstract: HPS is a significant complication of portal hypertension in children with chronic liver disease and is an established indication for LT. It is characterized clinically by the triad of pulmonary vascular dilatation causing hypoxemia in the setting of advanced liver disease. NRH, a cause of non-cirrhotic portal hypertension, is characterized by diffuse benign transformation of the hepatic parenchyma into small regenerative nodules with minimal or no fibrosis. Development of NRH and HPS in pediatric LT recipients has not been reported, although occasional cases have been reported in adult LT recipients. In this report, we discuss a case of a three-yr-old male who developed HPS, two yr after LT. Pulmonary and cardiac causes for hypoxemia were ruled out by appropriate investigations including a chest X ray, echocardiogram, cardiac catheterization, and a CT angiographic study. The diagnosis of HPS was confirmed via bubble echocardiogram that demonstrated intrapulmonary shunting. Open liver biopsy revealed marked NRH. The patient underwent liver retransplantation that resulted in complete reversal of his pulmonary symptoms and normal oxygen saturations within three months after LT.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital Los Angeles/Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Rabea
authors.initials: R
authors.lastname: Alhosh
authors.forename: Yuri
authors.initials: Y
authors.lastname: Genyk
authors.forename: Sophoclis
authors.initials: S
authors.lastname: Alexopoulos
authors.forename: Daniel
authors.initials: D
authors.lastname: Thomas
authors.forename: Shengmei
authors.initials: S
authors.lastname: Zhou
authors.forename: George
authors.initials: G
authors.lastname: Yanni
authors.forename: Nanda
authors.initials: N
authors.lastname: Kerkar
mesh_terms: D001706:Biopsy; D002675:Child, Preschool; D004452:Echocardiography; D005355:Fibrosis; D020065:Hepatopulmonary Syndrome / Q000628:therapy*; D006801:Humans; D006965:Hyperplasia / Q000628:therapy*; D006975:Hypertension, Portal / Q000628:therapy; D000860:Hypoxia / Q000628:therapy; D007165:Immunosuppression Therapy; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000628:therapy; D017114:Liver Failure, Acute / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: hepatopulmonary syndrome; liver transplantation; nodular regenerative hyperplasia