Impact of Hepatopulmonary Syndrome on Quality of Life and Survival in Liver Transplant Candidates

Michael B. Fallon, Michael Joseph Krowka, Robert S. Brown, James F. Trotter, Steven Zacks, Kari E. Roberts, Vijay Shah, Neil Kaplowitz, Lisa Forman, Keith Wille, Steven M. Kawut

Research output: Contribution to journalArticle

152 Citations (Scopus)

Abstract

Background & Aims: Hepatopulmonary syndrome (HPS) affects 10%-30% of patients with cirrhosis and portal hypertension, but the impact on functional status, quality of life, and survival is poorly defined. We assessed the impact of HPS in patients evaluated for liver transplantation. Methods: We performed a prospective multicenter cohort study of patients being evaluated for liver transplantation in 7 academic centers in the United States. Patients with HPS (defined as an increased alveolar-arterial oxygen gradient with intrapulmonary vasodilation) were compared with those without HPS in terms of demographics and clinical variables. New York Heart Association functional class, quality of life, and survival were assessed. Results: Seventy-two patients with HPS and 146 patients without HPS were compared. There were no differences in age, sex, or etiology or severity of liver disease between the groups; however, patients with HPS were less likely to have a history of smoking (P = .03). Patients with HPS had worse New York Heart Association functional class (P = .005) and had significantly worse quality of life in certain domains compared with patients without HPS. In addition, patients with HPS also had a significantly increased risk of death compared with patients without HPS despite adjustment for age, sex, race/ethnicity, Model for End-Stage Liver Disease score, and liver transplantation (adjusted hazard ratio = 2.41; 95% confidence interval, 1.31-4.41; P = .005). Conclusions: HPS was associated with a significant increase in risk of death as well as worse functional status and quality of life in patients evaluated for liver transplantation.

Original languageEnglish (US)
Pages (from-to)1168-1175
Number of pages8
JournalGastroenterology
Volume135
Issue number4
DOIs
StatePublished - Oct 2008

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Hepatopulmonary Syndrome
Quality of Life
Transplants
Survival
Liver
Liver Transplantation
End Stage Liver Disease
Portal Hypertension
Vasodilation

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Fallon, M. B., Krowka, M. J., Brown, R. S., Trotter, J. F., Zacks, S., Roberts, K. E., ... Kawut, S. M. (2008). Impact of Hepatopulmonary Syndrome on Quality of Life and Survival in Liver Transplant Candidates. Gastroenterology, 135(4), 1168-1175. https://doi.org/10.1053/j.gastro.2008.06.038

Impact of Hepatopulmonary Syndrome on Quality of Life and Survival in Liver Transplant Candidates. / Fallon, Michael B.; Krowka, Michael Joseph; Brown, Robert S.; Trotter, James F.; Zacks, Steven; Roberts, Kari E.; Shah, Vijay; Kaplowitz, Neil; Forman, Lisa; Wille, Keith; Kawut, Steven M.

In: Gastroenterology, Vol. 135, No. 4, 10.2008, p. 1168-1175.

Research output: Contribution to journalArticle

Fallon, MB, Krowka, MJ, Brown, RS, Trotter, JF, Zacks, S, Roberts, KE, Shah, V, Kaplowitz, N, Forman, L, Wille, K & Kawut, SM 2008, 'Impact of Hepatopulmonary Syndrome on Quality of Life and Survival in Liver Transplant Candidates', Gastroenterology, vol. 135, no. 4, pp. 1168-1175. https://doi.org/10.1053/j.gastro.2008.06.038
Fallon, Michael B. ; Krowka, Michael Joseph ; Brown, Robert S. ; Trotter, James F. ; Zacks, Steven ; Roberts, Kari E. ; Shah, Vijay ; Kaplowitz, Neil ; Forman, Lisa ; Wille, Keith ; Kawut, Steven M. / Impact of Hepatopulmonary Syndrome on Quality of Life and Survival in Liver Transplant Candidates. In: Gastroenterology. 2008 ; Vol. 135, No. 4. pp. 1168-1175.
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AU - Krowka, Michael Joseph

AU - Brown, Robert S.

AU - Trotter, James F.

AU - Zacks, Steven

AU - Roberts, Kari E.

AU - Shah, Vijay

AU - Kaplowitz, Neil

AU - Forman, Lisa

AU - Wille, Keith

AU - Kawut, Steven M.

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N2 - Background & Aims: Hepatopulmonary syndrome (HPS) affects 10%-30% of patients with cirrhosis and portal hypertension, but the impact on functional status, quality of life, and survival is poorly defined. We assessed the impact of HPS in patients evaluated for liver transplantation. Methods: We performed a prospective multicenter cohort study of patients being evaluated for liver transplantation in 7 academic centers in the United States. Patients with HPS (defined as an increased alveolar-arterial oxygen gradient with intrapulmonary vasodilation) were compared with those without HPS in terms of demographics and clinical variables. New York Heart Association functional class, quality of life, and survival were assessed. Results: Seventy-two patients with HPS and 146 patients without HPS were compared. There were no differences in age, sex, or etiology or severity of liver disease between the groups; however, patients with HPS were less likely to have a history of smoking (P = .03). Patients with HPS had worse New York Heart Association functional class (P = .005) and had significantly worse quality of life in certain domains compared with patients without HPS. In addition, patients with HPS also had a significantly increased risk of death compared with patients without HPS despite adjustment for age, sex, race/ethnicity, Model for End-Stage Liver Disease score, and liver transplantation (adjusted hazard ratio = 2.41; 95% confidence interval, 1.31-4.41; P = .005). Conclusions: HPS was associated with a significant increase in risk of death as well as worse functional status and quality of life in patients evaluated for liver transplantation.

AB - Background & Aims: Hepatopulmonary syndrome (HPS) affects 10%-30% of patients with cirrhosis and portal hypertension, but the impact on functional status, quality of life, and survival is poorly defined. We assessed the impact of HPS in patients evaluated for liver transplantation. Methods: We performed a prospective multicenter cohort study of patients being evaluated for liver transplantation in 7 academic centers in the United States. Patients with HPS (defined as an increased alveolar-arterial oxygen gradient with intrapulmonary vasodilation) were compared with those without HPS in terms of demographics and clinical variables. New York Heart Association functional class, quality of life, and survival were assessed. Results: Seventy-two patients with HPS and 146 patients without HPS were compared. There were no differences in age, sex, or etiology or severity of liver disease between the groups; however, patients with HPS were less likely to have a history of smoking (P = .03). Patients with HPS had worse New York Heart Association functional class (P = .005) and had significantly worse quality of life in certain domains compared with patients without HPS. In addition, patients with HPS also had a significantly increased risk of death compared with patients without HPS despite adjustment for age, sex, race/ethnicity, Model for End-Stage Liver Disease score, and liver transplantation (adjusted hazard ratio = 2.41; 95% confidence interval, 1.31-4.41; P = .005). Conclusions: HPS was associated with a significant increase in risk of death as well as worse functional status and quality of life in patients evaluated for liver transplantation.

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