Prevalence and Severity of Hepatopulmonary Syndrome and Its Influence on Survival in Cirrhotic Patients Evaluated for Liver Transplantation

Abstract

Both authors contributed equally to this work.The prevalence of hepatopulmonary syndrome (HPS) and its influence on survival before and after liver transplantation (LT) remain controversial. Additionally, the chronology of post-LT reversibility is unclear. This study prospectively analyzed 316 patients with cirrhosis who were evaluated for LT in 2002LT in -2007 177 underwent LT at a single reference hospital. HPS was defined by a partial pressure of arterial oxygen (PaO 2 ) <70 mmHg and/or an alveolar-arterial oxygen gradient (A-a PO 2 ) !20 mmHg in the supine position and positive contrast echocardiography. The prevalence of HPS was 25.6% (81/316 patients), and most patients (92.6%) had mild or moderate HPS. High Child-Pugh scores and the presence of ascites were independently associated with HPS. Patients with and without HPS did not significantly differ in LT waiting list survival (mean 34.6 months vs. 41.6 months, respectively; logrank, p ¼ 0.13) or post-LT survival (mean 45 months vs. 47.6 months, respectively; log-rank, p ¼ 0.62). HPS was reversed in all cases within 1 year after LT. One-fourth of the patients with cirrhosis who were evaluated for LT had HPS (mostly mild to moderate); the presence of HPS did not affect LT waiting list survival. HPS was always reversed after LT, and patient prognosis did not worsen. Hepatopulmonary syndrome (HPS) is characterized by blood oxygen changes that are caused by pulmonary vascular dilations in patients with liver disease (1,2). The criteria that are used to define HPS and the reported prevalence of HPS in patients with liver cirrhosis and in candidates for liver transplantation (LT) vary widely in the literature (4-32%) (3-7). The cause of HPS is unknown, and the association between liver dysfunction and portal hypertension remains controversial, as reported by different studies (4-10). Orthodeoxia is considered to be characteristic of HPS; however, the prevalence of this condition in patients with HPS is only 25% (1,11).The association between HPS and increased mortality in patients with cirrhosis who are candidates for LT has been disputed. A recent prospective multicenter study identified associations between HPS, independent of its severity, and increased mortality and poorer quality of life (7). Other studies of HPS and LT were retrospective (12) or were based on small sample sizes (6).LT is the treatment of choice for HPS. Early results of LT in patients with HPS have been disappointing and have

Assessing the kinetics of microbubble appearance in cirrhotic patients using transthoracic saline contrast‐enhanced echocardiography

“…The prevalence of HPS in cirrhotic patients listed for liver transplant varies from 4–32% 2 and its presence affects the quality of life and doubles the risk of death 3 ; therefore, recognition of the HPS is essential, particularly in patients in whom liver transplantation is a therapeutic option.…”

Predictors of Mortality and Early Detection Strategies for Hepatopulmonary Syndrome in Liver Transplant Patients

“…The LT due to HPS represent 1% of the liver transplants performed in our center during the period described, with an approximate post-LT survival of 62.5%, as compared to the series in other transplant centers that report a variable prevalence of 4-30% [7]. This reflects on the one hand a potential overdiagnosis of the institution in certain series, and on the other an underestimation in our own series.…”

Hepatopulmonary Syndrome: A Brief Review

“…Nevertheless, in some severe cases of hypoxemia, improvement may not be reached in only one year. These cases usually have a worse prognosis and a longer length of hospital stay [24][25][26].…”