Backgrounds: Hepato-pulmonary syndrome (HPS) is a complication of liver disease with liver transplantation as the only curative treatment. However these patients can develop severe hypoxemia early after transplantation, defined as a need of 100% oxygen to maintain a saturation of >85 %. The data regarding the prevalence of severe hypoxemia and its impact on outcome is limited.

Methods: Retrospective analysis of prospectively maintained database of 1700 patients who had liver transplants in our unit between 2007 and 2017, from which patients with a diagnosis of HPS were identified. Pre transplant variables related to HPS and postoperative oxygen requirement, duration of intubation, ICU stay, postoperative complications and survival data were collected.

Results: 32 (n=32) patients with HPS were identified during the study period. The median pre-transplant PaO2 on room air and intrapulmonary shunt ratio were 55.4mmHg and 18% (5.4-40.4%) respectively. Postoperative severe hypoxemia occurred in 7 patients (21%). Predictors of severe hypoxemia include intrapulmonary shunt ratio >20%, PaO2 on room air <50mmHg and diffusing capacity of the lung <38%. Among these 7 patients, 2 developed refractory severe hypoxemia after hospital discharge that led to mortality. ICU stay, readmission rate and medical cost of the hospital stay were significantly higher in patients who developed severe hypoxemia than the others. Overall 1 and 3 years post-transplant survival of HPS patients were 81% and 74% with 7 of 9 deaths related to other than respiratory failure.

Conclusions: Pre-transplant low PaO2 on room air, intrapulmonary shunt and diffusing capacity of lung predict the development of postoperative severe hypoxemia, which is associated with high morbidity and mortality. Refractoriness of hypoxemia may be related with the timing of onset. Overall post-transplant survival of HPS patients were comparable with other indications for liver transplant.

CITATION INFORMATION: Pitchaimuthu M., Fujiki M., Sasaki K., Hashimoto K., Eghtesad B., Miller C., Quintini C. Impact of Sever Hypoxemia after Liver Tansplantation in Hepatopulmonary Syndrome Am J Transplant. 2017;17 (suppl 3).

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