Excellent outcomes with liver transplantation in hepatopulmonary syndrome across pre-transplant PaO2 spectrum
Zakiyah Kadry,
Eric Schaefer,
Karen Krok,
Alison Faust,
Jonathan Gibson Stine,
Ian Roy Schreibman,
Dmitri Bezinover,
Thomas Roberts Riley, III
Affiliations
Zakiyah Kadry
Division of Transplantation, Department of Surgery, Penn State College of Medicine, Hershey, PA, USA; Corresponding author. Address: Division of Transplantation, The Pennsylvania State University, College of Medicine, 500 University Drive, H062, Hershey, PA 17033-0850, USA. Tel.: 717-531-5921; Fax: 717-531-5851.
Eric Schaefer
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
Karen Krok
Division of Gastroenterology and Hepatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
Alison Faust
Division of Gastroenterology and Hepatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
Jonathan Gibson Stine
Division of Gastroenterology and Hepatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
Ian Roy Schreibman
Division of Gastroenterology and Hepatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
Dmitri Bezinover
Department of Anesthesiology, Penn State College of Medicine, Hershey, PA, USA
Thomas Roberts Riley, III
Division of Gastroenterology and Hepatology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
Background & Aims: Significantly worse survival has been reported in patients with hepatopulmonary syndrome (HPS) and partial pressure of arterial oxygen (PaO2) 50 mmHg was 6.2%. Conclusions: Patients with a PaO2 <45 mmHg had a significantly higher rate of transplantation, and higher calculated MELD scores were associated with significantly higher pre-transplant mortality. Although post-transplant survival was lower in patients with a PaO2 <45 mmHg, the median survival was 11.5 years, and survival curves only became significantly different at 2.6 years. This suggests that patients with HPS do benefit from transplantation up to 2–3 years post-transplant regardless of the severity of pre-transplant hypoxaemia. Lay summary: A total of 1,152 patients with hepatopulmonary syndrome listed for liver transplant were analysed. Patients with a low PaO2 <45 mmHg had a high likelihood of transplantation. If associated with advanced liver disease, the mortality risk was higher for patients with hepatopulmonary syndrome on the wait list. After liver transplantation, patients with a PaO2 <45 mmHg had a lower survival, but this only became significant after 2.6 years, and the median survival was 11.5 years. This suggests that patients with hepatopulmonary syndrome do benefit from transplantation.
