Hepatopulmonary syndrome and liver transplantation: a review of the peroperative management of seven paediatric cases

Until recently, hypoxaemia was considered as a relative contraindication for liver transplantation. The hepatopulmonary syndrome associated with a right to left shunt of blood through the lungs is reversible in adults and children after correction of the cirrhosis by liver transplantation. However,...

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Bibliographic Details
Published in:Pediatric anesthesia 1998-01, Vol.8 (1), p.59-64
Main Authors: VAN OBBERGH, L., CARLIER, M., DE KOCK, M., OTTE, J., MOULIN, D., VEYCKEMANS, F.
Format: Article
Language:English
Subjects:
Adolescent
Anesthesia
Biological and medical sciences
Blood Pressure
Child
Child, Preschool
Chronic Disease
cirrhosis
Female
Gastroenterology. Liver. Pancreas. Abdomen
hepatopulmonary syndrome
Humans
hypoxaemia
Hypoxia - blood
Hypoxia - etiology
Liver Cirrhosis - complications
Liver Cirrhosis - physiopathology
Liver Cirrhosis - surgery
Liver Transplantation
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Other diseases. Semiology
Oxygen - blood
Postoperative Complications
Preoperative Care
Pulmonary Artery
Pulmonary Circulation
Pulmonary Wedge Pressure
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Summary:Until recently, hypoxaemia was considered as a relative contraindication for liver transplantation. The hepatopulmonary syndrome associated with a right to left shunt of blood through the lungs is reversible in adults and children after correction of the cirrhosis by liver transplantation. However, concerns have been raised regarding the risks of anaesthesia in such hypoxaemic patients. Since the peroperative management of children undergoing liver transplantation and suffering from hepatopulmonary syndrome and severe hypoxemia has never been described, we report here our experience in seven children. Despite the fact that severe arterial desaturation was recorded throughout the procedure, no major complications were recorded peroperatively. The postoperative intubation time was 58 ± 21 h, five children being extubated while still hypoxaemic. All seven patients reversed their hepatopulmonary syndrome after a mean postoperative period of 24±10 weeks. This shows that liver transplantation can be successfully achieved in severely hypoxaemic children and that postoperative correction of the right to left shunt is then obtained.
ISSN:1155-5645
1460-9592
DOI:10.1046/j.1460-9592.1998.00720.x