Living donor liver transplantation for end-stage liver disease with severe hepatopulmonary syndrome: Report of a case

Abstract

Hepatopulmonary syndrome (HPS) is a serious complication of terminal liver disease, which manifests as severe hypoxia without any pulmonary anatomic or functional causes. The precise indications for liver transplantation in patients with severe HPS also remain unclear. A 49-year old woman was referred to our department for investigation and management of liver cirrhosis with severe hypoxia (PaO(2), 38 mmHg). A pulmonary perfusion scintigram showed an intrapulmonary shunt ratio of 40%, confirming a diagnosis of severe HPS. She underwent living donor liver transplantation using a right lobe graft donated by her 27-year-old daughter. Her post-transplant graft function was excellent, and her oxygenation recovered slowly but steadily. She was discharged from hospital on posttransplant day 39 with an SpO(2) of 94% under 3 l/min of O(2), delivered nasally. Despite the severity of the HPS, her postoperative recovery was smooth after the liver transplant.

Improved severe hepatopulmonary syndrome after liver transplantation in an adolescent with end-stage liver disease secondary to biliary atresia

“…The intrapulmonary vascular shunts are identified by contrast-enhanced transthoracic or esophageal echocardiography (qualitative) or radionuclide lung perfusion scanning, using 99m Tc-macroaggregated albumin with brain uptake to measure the shunt fraction (quantitative) 6,7. Although radioactive lung-scan is able to stratify the severity of HPS,6,8 contrast-enhanced echocardiogram is a more sensitive and noninvasive method for diagnosis of HPS. In addition, physical examination, clubbing fingers, is important to diagnosis HPS.…”

Hepatopulmonary Syndrome and Liver Transplantation: A Recent Review of the Literature

“… 90 It may come to mind that living donor LT (LDLT) may be more suitable than deceased donor LT (DDLT) because of the advantages of immediate availability of graft and opportunity to stabilize patient before LT. 86 However, some reports have shown that complication rates are the same between LDLT and DDLT patients. 92 – 95 To improve survival after LT, patients who are on the waiting list should be screened properly, and adequate oxygen should be given. 89 It should be remembered that HPS patients who are not candidates for LT may be candidates for localized resection or coil embolization of the dilated pulmonary vessels as a palliative treatment.…”

Excellent outcome of living donor liver transplantation in patients with hepatopulmonary syndrome: a single centre experience

“… described 5% mortality in a series of 21 patients (5 LDLT, 16 DDLT), peritransplant hypoxemic respiratory failure in 24%, biliary complications in 38%, and bleeding or vascular complications in 29% patients. Reversal of HPS after LDLT has been well described, but the reports on LDLT in adults are confined to few case reports and a series . We report 100% survival in present series.…”