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Transplantation |

A Study of Hepatopulmonary Syndrome in Patients Admitted for Liver Transplant Evaluation in India

Amrut Sindhu Sanikop, MBBS; Raj Singh, MD
Author and Funding Information

Apollo Hospitals, Chennai, India


Chest. 2014;145(3_MeetingAbstracts):629A. doi:10.1378/chest.1823454
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Abstract

SESSION TITLE: Transplantation Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Mild hypoxia has been seen in approximately one third of patients with chronic liver disease (CLD). Hepatopulmonary syndrome (HPS) is an important cause in a patient with hypoxemia and CLD. HPS in patients with CLD modifies the line of management and determines the prognosis of the disease. HPS is characterized by arterial de-oxygenation, intrapulmonary vascular dilatation (IPVD) in the setting of liver disease. This study was undertaken to assess the prevalence of HPS and to find predictive value of respiratory parameters in the diagnosis of HPS in patients admitted for liver transplant evaluation.

METHODS: Prospective observational study.Fifty consecutive patients with evidence of CLD, admitted for liver transplant evaluation during October 2010 to October 2012 were included in the study. A detailed history was taken and clinical examination was done in all patients. Transthoracic contrast enhanced echocardiography, arterial blood gas analysis on room air, lung function tests and chest radiograph were done for all patients. The patients with arterial hypoxemia and a positive contrast echocardiogram were considered to have HPS.

RESULTS: Twelve (24%) out of the 50 patients evaluated had HPS. However of the 38 patients without HPS, 31 (62%) were found to have contrast enhanced echocardiographic evidence of IPVDs, but did not meet the diagnostic criteria for HPS. Four (8%) patients had mild and 8 (16%) had moderate HPS.

CONCLUSIONS: HPS has been well documented to affect the prognosis of patients for liver transplantation. This justifies the setting up of standardized diagnostic tests like CE-TTE, ABG to aid in the early diagnosis of HPS and hence forms an important part of pre-operative evaluation. Ours is a one of the few studies undertaken to study HPS in resource limited setting. The prevalence of HPS in our study was 24%.

CLINICAL IMPLICATIONS: Alveolar-arterial oxygen gradient and partial pressure of arterial oxygen were found to be sensitive clinical indicators for HPS. IPVD were frequent (62%), in patients who did not fulfill the criteria for HPS, probably indicating subclinical cases requiring follow-up.

DISCLOSURE: The following authors have nothing to disclose: Amrut Sindhu Sanikop, Raj Singh

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