Natural history of hepatopulmonary syndrome: Impact of liver transplantation

Karen L. Swanson, Russell H. Wiesner, Michael Joseph Krowka

Research output: Contribution to journalArticle

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Abstract

Few data exist concerning survival after the diagnosis of hepatopulmonary syndrome (HPS). Although orthotopic liver transplantation (OLT) frequently results in complete resolution of HPS, the relationship between transplantation and survival has not been described. The study rationale was to describe long-term survival in patients with HPS. Data were derived from patients diagnosed with HPS at Mayo Clinic (n = 61) between 1985 and 2002, including those undergoing OLT (n = 24) and those who did not (n = 37). A case-control, Kaplan-Meier survival analysis between HPS patients and 77 patients without HPS matched for liver disease cause, model for end-stage liver disease (MELD), severity of liver disease by the Child classification, and age was described for OLT and non-OLT groups. Patients with HPS had a mean partial pressure of arterial oxygen (PaO2) decline of 5.2 + 2.3 mm Hg per year awaiting OLT. For HPS patients, despite similar baseline PaO2, brain uptake of technetium macroaggregated albumin (99mTcMAA), or measures of hepatic dysfunction, 5-year survival associated with OLT was 76% versus 23% who did not undergo transplantation (P < .0001). Comparing those who did not undergo transplantation, HPS patients had worse 5-year survival than matched controls (P = .0003). However, reasons to deny OLT (comorbidity) in the setting of HPS may well have contributed to observed survival differences. Baseline PaO2 ≤50 mm Hg was associated with worse survival irrespective of the decision to perform OLT. In conclusion, hypoxemia of HPS is frequently progressive. As OLT outcome relates to pretransplantation PaO2, additional MELD points should advance the priority for OLT in HPS.

Original languageEnglish (US)
Pages (from-to)1122-1129
Number of pages8
JournalHepatology
Volume41
Issue number5
DOIs
StatePublished - May 2005

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Hepatopulmonary Syndrome
Liver Transplantation
Survival
End Stage Liver Disease
Transplantation
Liver Diseases
Partial Pressure
Technetium
Kaplan-Meier Estimate
Survival Analysis

ASJC Scopus subject areas

  • Hepatology

Cite this

Natural history of hepatopulmonary syndrome : Impact of liver transplantation. / Swanson, Karen L.; Wiesner, Russell H.; Krowka, Michael Joseph.

In: Hepatology, Vol. 41, No. 5, 05.2005, p. 1122-1129.

Research output: Contribution to journalArticle

Swanson, Karen L. ; Wiesner, Russell H. ; Krowka, Michael Joseph. / Natural history of hepatopulmonary syndrome : Impact of liver transplantation. In: Hepatology. 2005 ; Vol. 41, No. 5. pp. 1122-1129.
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