Hepatopulmonary Syndrome Increases the Postoperative Mortality Rate Following Liver Transplantation: A Prospective Study in 90 Patients

Schiffer, Eduardo; Majno, Pietro; Mentha, Gilles; Giostra, Emiliano; Burri, Haran; Klopfenstein, Claude-Eric; Beaussier, Marc; Morel, Philippe; Hadengue, Antoine; Pastor, Catherine M.

doi:10.1111/j.1600-6143.2006.01334.x

Cited by 102 publications

(73 citation statements)

References 31 publications

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“…Schenk et al 44 have demonstrated that mortality in HPS correlated with the severity of hypoxemia and was independent of Child-Pugh classification. Schiffer et al 45 found no relationship between MELD score and IPVD among patients undergoing LT. Although not statistically significant, the finding of higher MELD and MELD-Na scores in our IPVD group supports the possibility of more severe liver disease in the IPVD group.…”

Section: Discussionmentioning

confidence: 97%

Intrapulmonary vascular dilatations are common in portopulmonary hypertension and may be associated with decreased survival

et al. 2015

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MinnesotaHepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH) are pulmonary vascular complications of portal hypertension with divergent clinicopathologic features and management. The presence of intrapulmonary vascular dilatations (IPVDs), detected by agitated saline contrast-enhanced transthoracic echocardiography (cTTE), is an essential feature of HPS but is not typically characteristic of POPH. Although IPVDs have been reported rarely in POPH, the prevalence and significance of this finding have not been systematically studied. We conducted a retrospective chart review of 80 consecutive patients diagnosed with POPH from January 1, 2002 to June 30, 2014 with documentation of cTTE findings, pulmonary hemodynamics, oxygenation, and survival. A total of 34 of the 80 patients (42%) underwent cTTE during initial diagnosis of POPH. IPVDs were detected in 20/34 patients (59%); intracardiac shunting was detected in 9/34 patients (26%; 4 also had IPVDs); and 9 patients (26%) had negative cTTE with no evidence of IPVD or intracardiac shunting. Patients with IPVD had decreased survival as compared to those without IPVD (P 5 0.003), a trend that persisted after exclusion of liver transplant recipients (P 5 0.07). The IPVD group had a trend toward higher Model for End-Stage Liver Disease score with and without incorporating sodium (MELD or MELD-Na; P 5 0.05 for both). The right ventricular index of myocardial performance (RIMP) was lower in the IPVD group (median, 0.4 versus 0.6; P 5 0.006). Patients with moderate or large IPVDs (n 5 6) had worse oxygenation parameters (partial pressure of arterial oxygen, diffusing capacity of the lung for carbon monoxide, and alveolar-arterial oxygen gradient) as compared to the rest of the cohort. Unexpectedly, IPVDs were frequently documented in POPH and associated with decreased survival. To further understand this observation, we recommend screening for IVPD in all patients with POPH. Liver Transpl 21:1355-1364, 2015. V C 2015 AASLD.Received March 25, 2015; accepted June 11, 2015. Abbreviations: A1AT, alpha-1-antitrypsin; A-a, alveolar-arterial; AIH, autoimmune hepatitis; ALD, alcoholic liver disease; ARDS, acute respiratory distress syndrome; ATN, acute tubular necrosis; CO, cardiac output; cTTE, contrast-enhanced transthoracic echocardiography; DLCO, diffusing capacity of the lung for carbon monoxide; DPG, diastolic pulmonary pressure gradient; ESLD, end-stage liver disease; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HPS, hepatopulmonary syndrome; INR, international normalized ratio; IPVD, intrapulmonary vascular dilatation; IQR, interquartile range; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; MELD-Na, Model for End-Stage Liver Disease incorporating sodium; MPAP, mean pulmonary artery pressure; N/A, not available; Na, sodium; NASH, nonalcoholic steatohepatitis; PA, pulmonary artery; PAH, pulmonary arterial hypertension; PaO 2 , partial pressure of arterial oxygen; PCWP, pulmonary capillary wedge pressure; PEA, pulseless elect...

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Section: Discussionmentioning

confidence: 97%

Intrapulmonary vascular dilatations are common in portopulmonary hypertension and may be associated with decreased survival

et al. 2015

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“…5,9 After the management guidelines for HPS were published, in which PA-a,O 2 ≥ 15 mmHg in liver disease patients with IPVD was deemed sufficient for confirmation of HPS, it was suggested that PaO 2 should no longer be a separate diagnostic criterion and should also become part of the classification of the syndrome, with prognostic significance. 5,59 HPS may therefore be classified as mild in cases of PaO 2 ≥ 80 mmHg, moderate in cases of PaO 2 < 80 mmHg or ≥ 60 mmHg, severe in cases of PaO 2 < 60 mmHg or ≥ 50 mmHg and very severe in cases of PaO 2 < 50 mmHg. 5 …”

Section: Arterial Gas Analysismentioning

confidence: 99%

“…61,[87][88][89] It should be stressed that this is a recent indication, since HPS was previously considered to be a contraindication for liver transplant surgery. 64 Because HPS may be an independent risk factor for worse prognosis among liver transplant candidates, 14,59 there is a current formal recommendation to prioritize transplantation for patients with the severe form of this syndrome. 18,22 However, each HPS case that is considered severe should be analyzed individually because of the high morbidity and mor-tality rates associated with this condition, both during surgery and during the postoperative period.…”

Section: Hps Treatment and Prognosismentioning

confidence: 99%

Hepatopulmonary syndrome: an update

Macedo

Lopes

2009

Sao Paulo Med. J.

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Hepatopulmonary syndrome (HPS) is a clinical threesome composed of liver disease, intrapulmonary vascular dilatation (IPVD) and arterial gas abnormalities. Its occurrence has been described in up to 32% of cirrhotic candidates for liver transplantation. It also affects non-cirrhotic patients with portal hypertension. Its pathogenesis is not well defined, but an association of factors such as imbalance in the endothelin receptor response, pulmonary microvascular remodeling and genetic predisposition is thought to lead to IPVD. Diagnosis is based on imaging methods that identify these dilatations, such as contrast echocardiography or perfusion scintigraphy with RESUMOA síndrome hepatopulmonar (SHP) é considerada uma tríade clínica composta de doença hepática, dilatações vasculares intrapulmonares (IPVD) e alterações de gases arteriais. Há descrição de sua ocorrência em até 32% dos cirróticos candidatos ao transplante de fígado, acometendo também não cirróticos com hipertensão portal. Sua etiopatogenia não está bem definida, mas se especula que a associação de fatores como o desequilíbrio na resposta dos receptores vasculares de endotelina, o remodelamento microvascular pulmonar e a predisposição genética propiciem as IPVD. O diagnóstico baseia-se em métodos de imagem que identifiquem essas dilatações, como a ecocardiografia com contraste ou a cintilografia de perfusão com 99m Tc, além da análise de gases arteriais, para identificar elevação da diferença alvéolo-arterial de O 2 ou hipoxemia. Não existe tratamento medicamentoso eficaz e sua resolução completa ocorre apenas com o transplante de fígado. A importância do diagnóstico da SHP está em priorizar os candidatos ao transplante, uma vez que sua presença está associada ao pior prognóstico. O objetivo deste artigo é fazer revisão das teorias de etiopatogenia da

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“…7,9,10 Low partial pressure of arterial carbon dioxide (PaCO 2 ) measurements are commonly found in patients with HPS Box 1 Treatments for hepatopulmonary syndrome.…”

Section: Pastor Is the Chief And E Schiffer Is A Principal Investimentioning

confidence: 99%

Therapy Insight: hepatopulmonary syndrome and orthotopic liver transplantation

Pastor¹,

Schiffer²

2007

Nat Rev Gastroenterol Hepatol

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Hepatopulmonary syndrome (HPS)--a pulmonary complication observed in patients who have chronic liver disease and/or portal hypertension--is attributed to intrapulmonary vascular dilatation and induces severe hypoxemia. HPS is mainly detected when patients are included on the waiting list for orthotopic liver transplantation (OLT) and can be diagnosed by blood gas analysis, transthoracic contrast-enhanced echocardiography or body scan with (99m)Tc-labeled macroaggregated albumin perfusion. When the partial pressure of arterial oxygen (PaO(2)) is >or=80 mmHg, it is unlikely that the patient has HPS. When the PaO(2) is <80 mmHg, imaging techniques should be used to confirm or exclude pulmonary vascular dilatation. When a diagnosis of HPS is confirmed, knowing the degree of hypoxemia is crucial for optimum patient management. Patients who have a PaO(2) >or=50 mmHg but <60 mmHg should be prioritized for OLT. This procedure is not indicated for patients with a PaO(2) between 60 mmHg and 80 mmHg, although follow-up every 3 months is recommended to detect any deterioration of the PaO(2). A PaO(2) of <50 mmHg might preclude OLT, because mortality and morbidity after OLT are greatly increased in these patients

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Hepatopulmonary Syndrome Increases the Postoperative Mortality Rate Following Liver Transplantation: A Prospective Study in 90 Patients

Cited by 102 publications

References 31 publications

Intrapulmonary vascular dilatations are common in portopulmonary hypertension and may be associated with decreased survival

Intrapulmonary vascular dilatations are common in portopulmonary hypertension and may be associated with decreased survival

Hepatopulmonary syndrome: an update

Therapy Insight: hepatopulmonary syndrome and orthotopic liver transplantation

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