Background:

Liver transplantation (LT) for hepatopulmonary syndrome (HPS) is well established. However, the outcomes of LT in severe HPS are not widely reported.

Methods:

Review of a Liver Transplant Database at a single institution between 1999 to 2012.

Results:

883 LT were performed over the 13-year period. 11 (1%) were performed for HPS. Six patients had very severe HPS (pa02 <50) and 5 had severe HPS (pa02 50-60) by 2004 European Respiratory Society criteria. Mean MELD score was 16 (range 11-30). Mean preoperative room air PaO2 was 48.9 mmHg (range 41-59). All patients had positive preoperative bubble echocardiograms. Five patients had pulmonary complications (pneumonia 2, pleural effusion 2, empyema 1) – four required tracheostomy. The mean days on ventilator were 16 (range 1-63). There was no association between pre-op hypoxia and the need for tracheostomy (p 0.819). With the exception of 1 patient, all patients were weaned off oxygen; mean time for complete cessation of O2 was 129.5 days (range 35-276). Five patients had biliary complications (5 strictures, 1 leak). Five patients had hepatic vascular complications (hepatic artery thrombosis 2; hepatic artery stenosis 3) with mortality in two. Causes of death were hepatic artery thrombosis with liver necrosis in one patient, and hepatic artery stenosis, also with liver necrosis, in the second patient. One-year patient-and-graft survival was 82% and 82% respectively. Our data has not shown any significant association between biliary( p 0.376), vascular (p 0.819), and pulmonary( p 0.74) complications when comparing severe and very severe HPS.

Conclusion:

These data confirm good survival rates and reversibility of severe HPS with liver transplantation. However, there appears to be an increased incidence (45%) of biliary and vascular complications, perhaps related to preop hypoxemia.

« Back to 2013 American Transplant Congress