22. Living Donor Liver Transplantation for Moderate to Very Severe Hepatopulmonary Syndrome: An Experience of 24 Patients

Abstract

Background and Aims: Hepatopulmonary syndrome (HPS) in patients with cirrhosis worsens the prognosis and liver transplantation is only definitive treatment. In countries with less cadaveric donation, patients with HPS have risk of significantly worsening and mortality while on waiting list. Living donor liver transplantation (LDLT) offers option of early transplantation. Methods: HPS was confirmed in presence of low PaO2 and macro-aggregated albumin (MAA) scan shunt fraction >6%; severity of HPS was defined as moderate (PaO2 >60 to < 80), severe (PaO2 >50 to < 60) and very severe (PaO2< 50). Twenty five patients were planned for LDLT; one surgery was abandoned due to persistent hypoxia, and 24 underwent LDLT for HPS and were included in retrospective analysis. Results: The study group comprised of 21 males and 3 females; mean age 50±8.7 years. Most common presentation was progressive dyspnea. Prior to LDLT, the mean model for end-stage liver disease score (without extra points) was 16.9±4.5 and Child's score was 9.2±2.1. The commonest etiology of cirrhosis was cryptogenic (n = 11,45.8%). The mean PaO2 was 59 mm Hg, and the mean shunt fraction was 22%. Seven patients (29.1%) had very severe while five (20.8%) had severe HPS. All patients underwent right lobe LDLT. The median overall time to extubation was 2 days (range 1–32) and ICU stay was 6 days (3–20). The main complications in post-LT course were bacterial infection in 6 (25%), CMV viremia in 5 (20.8%), acute cellular rejection in 2 (8.3%) and biliary leak/stricture in 1 (4%) patients. One patient had mortality in very severe group due to sepsis in first week after LDLT, rest are doing well at a follow up of 71±41 months. Seventeen LDLT recipients were off oxygen at the time of discharge from hospital. Conclusions: We report one of the largest series of LDLT in HPS with good results even in very severe cases. The authors have none to declare.