Liver transplantation for hepatopulmonary syndrome: A ten-year experience in Paris, France

Abstract

Our data strongly support the role of orthotopic liver transplantation in adult patients with HPS, regardless of its severity.

Natural history of hepatopulmonary syndrome: Impact of liver transplantation

“…In a retrospective review from 4 transplant centers (23 HPS patients) in Paris, France, Taille et al 6 showed that the mortality was 30.5% (7/23; six deaths within 6 months of OLT). 6 Perioperative mortality (2 deaths of multiorgan failure and refractory hypoxemia within 90 days of OLT) was 8.5%. Pre-OLT, 5 of 7 HPS patients had PaO 2 Ͻ 60 mm Hg.…”

“…First, HPS has been shown to have an independent adverse effect on mortality before liver transplantation, 11 and second, complete resolution of HPS frequently occurs in patients surviving the transplant hospitalization. 1,5,6 If the patient survives the immediate postoperative course (intensive care unit/ transplant hospitalization), there is a high likelihood of normalization of arterial oxygenation over time (many months) with little chance of recurrence of HPS. 1,5,6,11,12 Several distinctions should be emphasized between our data and the survival analysis reported by Schenk et al 12 in 27 HPS patients.…”

“…1,5,6 If the patient survives the immediate postoperative course (intensive care unit/ transplant hospitalization), there is a high likelihood of normalization of arterial oxygenation over time (many months) with little chance of recurrence of HPS. 1,5,6,11,12 Several distinctions should be emphasized between our data and the survival analysis reported by Schenk et al 12 in 27 HPS patients. Despite similarities in mean age (51-53 years) and percentage of those with Child C severity of liver disease (51%-56%), survival was much worse in Schenk et al's patients with PaO 2 Ͻ60 mm Hg (n ϭ 12), having 25% survival at 6 months.…”

“…4 Although orthotopic liver transplantation (OLT) has become the mainstay of therapy for HPS in many centers, few data exist that describe long-term survival. 1,5 Despite the well-documented resolution of HPS after OLT, 1,5,6 we were interested in the long-term clinical course of all patients with this syndrome since the inception of the liver transplantation program at Mayo Clinic Rochester in 1985. Our aims were to determine longterm survival in HPS versus case controls, assess the impact of OLT on survival, and document partial pressure of arterial oxygen (PaO 2 ) change pre-and post-OLT.…”

Molecular mechanisms of hepatopulmonary syndrome

“…If HPS develops, the risk of death in the next year is 41%. This syndrome can be considered as a separate indication for a liver transplant [13][14][15][16], but at the same time the severe hypoxia in the case of HPS is associated with a high risk of liver transplant complications (30% during the first 90 days) and increased gap between the transplant surgery and improvement in arterial oxygenation [17]. This complication is seen in 6-21% of the patients and carries a 45% chance of mortality [18].…”