Preoperative pulmonary assessment of children for liver transplantation

Abstract

Pulmonary assessment should be part of the preoperative investigation of pediatric patients with chronic liver disease undergoing liver transplantation, as it allows the identification of pulmonary alterations that influence candidacy for transplantation and survival. To describe pulmonary changes found in pediatric patients who were candidates for liver transplantation. Retrospective study of 17 pediatric liver transplant candidates undergoing preoperative pulmonary evaluation assessing pulmonary clinical data, arterial blood gas analysis, CXR, respiratory function test by spirometry, pulmonary scintigraphy, and CEE. Ten patients presented normal chest roentgenograms. The most common radiographic change was interstitial infiltrate in the lung bases. Of the five patients with PaO(2) <70 mmHg, four had cyanosis and dyspnea and two were diagnosed with HPS with intrapulmonary shunt evidenced by contrast echocardiogram. Two patients presented with intrapulmonary shunt but without hypoxemia. Spirometry was normal in six patients, restrictive disturbance was evidenced in one patient, obstructive in three, and combined in two. The most common scintigraphic change was heterogeneous pulmonary perfusion. Pulmonary assessment should be performed routinely in pediatric patients prior to liver transplantation, even in asymptomatic patients. Pulmonary assessment may indicate changes such as HPS that can increase postoperative morbidity/mortality.

Pulmonary Evaluation in Pediatric Liver Transplant Candidates

“…Also, the most common abnormal finding in chest radiograph was interstitial infiltration followed by diaphragmatic elevation and perihilar infiltration. These results are somewhat similar to that of a Brazilian study by Alves et al [11]. They showed that the most common abnormal finding in chest radiograph was interstitial infiltration of basilar parts of the lungs.…”

“…They showed that the most common abnormal finding in chest radiograph was interstitial infiltration of basilar parts of the lungs. Among clinical problems, cyanosis and dyspnea were more common in these patients [11]. Since about 60% of the present patients had normal chest radiograph, this diagnostic modality cannot be used as a conclusive method for routine pulmonary assessment of pediatric patients with end stage liver disease who are candidates for LT.…”

“…The mean Child score of patients was 9.5±1.9 (range, [7][8][9][10][11][12][13][14], and the mean PELD score was 19.6±12.1 (range, 3-65).…”

Evaluation of liver transplant candidates: A pulmonary perspective

“…It is diagnosed by an increase in mean pulmonary artery pressure (PAP) of ≥25 mmHg, with an elevated pulmonary vascular resistance (>240 dyn/s/cm) and a normal pulmonary capillary wedge pressure (<15 mmHg). [1] It is classified as severe when mean PAP ≥ 45 mmHg, moderate when mean PAP is between 34 and 44 mmHg and mild when mean PAP is between 25 and 34 mmHg. [19] Around 20% of patients with cirrhosis have been shown to have an increase in PAP.…”

“…It is so common that around half of patients with advanced liver disease have been reported to be hypoxemic. [1] Both lung parenchyma and pleural space might be affected in patients with chronic liver disease. The impairment in pulmonary function in cirrhotic patients is multifactorial.…”