Outcomes of liver transplantation for hepatopulmonary syndrome in patients with concomitant respiratory disease.

Abstract

Concomitant respiratory disease is a common finding in patients with hepatopulmonary syndrome (HPS). Among patients who underwent liver transplantation (LT) for HPS, we compared characteristics and outcome of patients with versus without concomitant respiratory disease. This single center retrospective observational study included patients with HPS who underwent LT between 1999 and 2020. During the study period, 32 patients with HPS received a LT; nine (28%) with concomitant respiratory disease of whom one required a combined lung-liver transplantation. Patients with concomitant respiratory disease had higher PaCO2 (38 vs. 33mm Hg, p=.031). The 30-day postoperative mortality was comparable, but the estimated cumulative probability of resolution of oxygen therapy after LT in HPS patients with versus those without concomitant respiratory disease was lower: 63% versus 91% at 12months and 63% versus 100% at 18months (HR 95% CI .140-.995, p=.040). In addition to the presence of concomitant respiratory disease (p=.040), history of smoking (p=.012), and high baseline 99mTcMAA shunt fraction (≥20%) (p=.050) were significantly associated with persistent need of oxygen therapy. The 5-year estimated cumulative probability of mortality in patients with concomitant respiratory disease was worse: 50% versus 23% (HR 95% CI .416-6.867, p=.463). The presence of a concomitant respiratory disease did not increase the short-term postoperative mortality after LT in patients with HPS. However, it resulted in a longer need for oxygen therapy.