PURPOSE: End stage liver disease(ESLD) is associated with many pulmonary abnormalities. Conflicting reports suggest a role for Hepatitis C virus (HCV) in the pathogenesis of idiopathic pulmonary fibrosis. Our study explores the differences in pulmonary function tests (PFT) in patients with ESLD due to HCV and non-HCV related causes.
METHODS: We reviewed 353 charts of patients being evaluated for liver transplant from 1999-2005 in a tertiary center for advanced liver disease. Complete PFTs were done in 68 patients that included spirometry, lung volumes (TLC) and diffusing capacity (DLco). Demographics, hepatitis serology, smoking history and presence of ascites were recorded. Comparison of PFTs between HCV and non-HCV patients was done using the Fischer exact test and the two-sample t test.
RESULTS: We found that out of the 68 ESLD patients, 32 had HCV and 36 were non HCV-related [alcohol induced (23), cryptogenic (7), non alcoholic steatohepatitis (3), hepatitis B (1), drug (1) and sclerosing cholangitis (1)]. Out of the 32 patients with HCV, 17 had abnormal PFTs (restrictive=13(41%) and obstructive=4(12%)) and of the 36 non-HCV patients 15 had abnormal PFTs (restrictive=11(31%) and obstructive=4(11%)). No statistically significant difference was observed in the two groups (Fischer exact value=0.65). Ascites was equally distributed in the two etiological groups. 64% of the patients were smokers (71% of HCV and 58% of non HCV patients).
CONCLUSION: There was a uniform trend towards lower values for FEV1, TLC, FVC and DLCO in HCV as compared to non HCV patients, but did not reach statistical significance. Restrictive pattern was the most common finding. We could not detect a difference in the PFT patterns between HCV and non HCV related ESLD patients.
CLINICAL IMPLICATIONS: A significant number of patients with ESLD have abnormal PFTs likely secondary to multiple factors like ascites, effusions, muscle wasting, pain and substance abuse like smoking. It appears unlikely that PFT patterns differ according to etiology of ESLD.
DISCLOSURE: Hakim Ali, None.