Hepatopulmonary Syndrome: Morbidity and Survival After Liver Transplantation

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, O-2 >= 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,O-2 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.