Prospective evaluation of postoperative outcome after liver transplantation in hepatopulmonary syndrome

OBJECTIVE: To determine the frequency of hepatopulmonary syndrome in orthotopic liver transplantation (OLT) patients with chronic end-stage-liver-disease, and the short-term and long-term postoperative outcome of HPS patients after OLT. METHODS: This prospective study included 31 HPS patients and 30 case control non-HPS patients. The preoperative condition was similar between the two groups. 26 of 31 HPS patients and all non-HPS patients underwent OLT. Standardized methods such as arterial blood gas at room air and 99m-technetium macroaggregated albumin (99mTcMAA) lung and brain perfusion scanning were performed for the diagonosis of HPS. Patients were followed up after OLT. RESULTS: The incidence of HPS in OLT patients was 9.32% (26/279). Hypoxemia in HPS was obviously improved with normalized shunt of 99mTcMAA in lungs after OLT. The immediate postoperative survival rate (within 28 days after OLT) of HPS was 76.92%(20/26). The one year survival was 61.54% (16/26), and four-year survival was 57.69% (15/36), much higher than those of HPS patients without OLT (0%). But high postoperative morbidity and mortality were observed in HPS patients. CONCLUSION: Liver transplantation was an effective treatment for HPS. But the postoperative mortality rate following OLT in HPS patients was still much higher than that of patients without HPS.