Hepatopulmonary syndrome in waiting list and liver transplant

Abstract

Background: Hepatopulmonary Syndrome (HPS) is an important pulmonary complication in cirrhotic patients with portal hypertension. Nevertheless, it is often not recognized in clinical practice, which results in inadequate treatment. The aim of this study was to evaluate the prevalence of HPS in patients who underwent liver transplantation (LT) and its impact in MELD (Model End-Stage Liver Disease) exception points policy. Methods: Retrospective study of all patients who underwent LT at our center from 2002 to 2019 combined with a cross-sectional and observational analysis of patients on waitlist on April 2019. Demographic and laboratory data as well as transthoracic contrast echocardiography findings and survival were analyzed from medical charts. Results: A total of 1395 LT were performed from 2002 to 2019. Exception MELD points due to HPS were assigned to 18 patients and 12 of them (0.85% of all LT) were transplanted. On April 2019, there were 150 patients on our waitlist, of which 12 (8%) met the criteria diagnosis for HPS, with 4 patients (33.3%) considered as mild, 4 (33.3%) as moderate, 2 (16.7%) as severe and 2 (16.7%) as were very severe. Four patients met the criteria for receiving MELD exception points due to HPS, nevertheless only 1 (25%) received the extra punctuation. Conclusion: HPS severely impacts prognosis on LT waitlist, making it paramount to achieve early diagnosis and obtain MELD exception points in order to perform LT as soon as possible.

Keywords

• Liver transplantation
• Hepatopulmonary syndrome
• Waiting list