Liver transplantation for hepatopulmonary syndrome: A ten-year experience in Paris, France

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Abstract
Background. Although the possibility of reversing hepatopulmonary syndrome (HPS) after liver transplantation is now well established, the proportion of patients in whom reversibility is observed and the time to resolution of HPS remain uncertain. Methods. We analyzed the outcome of all adult patients with HPS who underwent orthotopic liver transplantation in all the liver transplant centers in Paris, during a 10-year period. Results. Twenty-three adult patients (median age, 47 years; range, 14–64) underwent transplantation in four institutions. Median PaO2 was 52 (range, 32–67) mm Hg and median alveolar-arterial oxygen gradient was 66 mm Hg. When patients were breathing 100% O2, median PaO2 was 310 (range, 74–663) mm Hg. Median isotopic shunt ratio was 33% (range, 0–80%). The overall mortality during the study period was 30.5% (7/23). Perioperative mortality was 8.5%, whereas late mortality was 22%. None of the preoperative characteristics of HPS (isotopic shunt ratio, PaO2 on room air or on 100% oxygen) was associated with overall postoperative mortality. Of the 21 patients surviving the perioperative period (median follow-up, 17 months; range, 0.5–72), a decrease in alveolar-arterial oxygen gradient of at least 5 mm Hg and at least 10 mm Hg was observed in 21 of 21 and in 18 of 21 patients, respectively, with great variations in the time of improvement. The threshold of 70 mm Hg was reached in 15 patients. The lower the preoperative PaO2, the longer the time to reach this point. Conclusion. Our data strongly support the role of orthotopic liver transplantation in adult patients with HPS, regardless of its severity.