Excellent outcomes with liver transplantation in hepatopulmonary syndrome across pre-transplant PaO2 spectrum

Abstract

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Hepatopulmonary syndrome

“… 63 Although post-LT survival was lower in patients with PaO 2 <45 mmHg, the outcomes were still good, given the median survival of 11.5 years, compared to 14.1 years in patients with PaO 2 ≥45 to <50 mmHg. 63 In any case, patients with severe HPS should be referred to specialised high-volume LT centres, with experience of treating severe post-LT hypoxemia.…”

“…A recent study, extending the UNOS database study through 2019, found that overall survival was not different between patients with PaO2 <45 mmHg, 45 to <60 mmHg and ≥60 mmHg [63]. Although post-LT survival was lower in patients with PaO2 <45 mmHg, the outcomes were still good, given the median survival of 11.5 years, compared to 14.1 years in patients with PaO2 ≥45 to <50 mmHg [63]. In any case, patients with severe HPS should be referred to specialized highvolume LT centers, experienced with post-LT interventions to treat severe post-LT hypoxemia.…”

“…Data from large studies in the US and Europe, as well as a recent systematic review, indicate that, since the implementation of the MELD SE policy, outcomes in patients with HPS have been significantly better than they were in the pre-MELD era. 56 , 57 , [61] , [62] , [63] There have been discussions to determine the degree of hypoxemia at which patients with HPS will benefit from LT and still be able to achieve satisfactory post-LT outcomes. Earlier studies associated very severe HPS with an increased risk of complications and mortality after LT. 64 Analyses from the United Network for Organ Sharing (UNOS) database (from 2002-2012) indicated that post-LT outcome is similar in patients with HPS and without HPS, except in those with very severe HPS (PaO 2 ≤44 mmHg).…”

“…Data from large studies in the USA and Europe, as well as a recent systematic review, indicated that since the implementation of the MELD SE policy the outcome in patients with HPS has significantly improved compared to the pre-MELD era [56,57,[61][62][63]. There has been discussion on the determination of the degree of hypoxemia at which patients with HPS benefit from LT without compromising their post-LT outcomes.…”

“…Analyses from the UNOS database (from 2002-2012) indicated that post-LT outcome is similar in patients with HPS and without HPS, except in those with very severe HPS (PaO2 ≤44 mmHg) [56]. A recent study, extending the UNOS database study through 2019, found that overall survival was not different between patients with PaO2 <45 mmHg, 45 to <60 mmHg and ≥60 mmHg [63]. Although post-LT survival was lower in patients with PaO2 <45 mmHg, the outcomes were still good, given the median survival of 11.5 years, compared to 14.1 years in patients with PaO2 ≥45 to <50 mmHg [63].…”