Hepatopulmonary Syndrome: Morbidity and Survival After Liver Transplantation

• Published in: Transplantation proceedings 2008-12, Vol.40 (10), p.3512-3516
• Main Authors: Deberaldini, M, Arcanjo, A.B.B, Melo, E, da Silva, R.F, Felício, H.C.C, Arroyo, P.C, Duca, W.J, Cordeiro, J.A, da Silva, R.C.M.A
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood Gas Analysis; Echocardiography, Transesophageal; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatopulmonary Syndrome - diagnostic imaging; Hepatopulmonary Syndrome - surgery; Humans; Liver Transplantation - mortality; Liver Transplantation - statistics & numerical data; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Oxygen - blood; Pneumology; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Survivors - statistics & numerical data; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.08.134

Abstract Hepatopulmonary Syndrome (HPS) is a triad of liver disease, intrapulmonary vascular dilatation (IPVD), and arterial deoxygenation. Orthotopic liver transplantation (OLT) constitutes the only effective treatment; however, adverse outcomes have been reported. The aim of this study was to evaluate the early morbidity and short- and long-term survival after OLT for patients with and without HPS. We studied 59 transplant recipients divided into 2 groups: with HPS (HPS group n = 25) and without HPS (control group, n = 34) before the OLT. IPVD was diagnosed using transthoracic contrast-enhanced echocardiography. Arterial deoxygenation was defined as PA-a,O2 ≥ 15 mm Hg. The HPS and control groups were homogeneous regarding age ( P = .36; 43.8 ± 12.2 vs 46.9 ± 13.5), gender ( P = .47), male/female ratio (68%:32% and 78%:22%, respectively), and severity of liver disease. The PaO2 was significantly lower (74.9 ± 12.1 vs 93 ± 6.4 mm Hg; P < .001) and the PA-a,O2 was significantly higher in the HPS group (30.3 ± 10.6 vs 11.0 ± 7.0; P < .001). The percentage of severe (n = 3) and very severe (n = 1) hypoxemia was 16%. There were no significant differences between HPS and control groups regarding short- (68% vs 77%; P = .27) and long-term survival (60% vs 64%; P = .67) as well as among patients with mild, moderate, severe, or very severe HPS and the control group ( P = .53). Also, intensive care unit (ICU) stay (7.0 vs 5.5; P = .41), duration of mechanical ventilation (38.0 vs 27.5; P = .43), reintubation rate (32.0% vs 23.5%; P = .45), and early postoperative complications ( P = .72) were not different. In conclusion, there were no significant differences regarding the outcomes of OLT for patients with versus without HPS related to early morbidity or short- and long-term survival.