Prognostic value of respiratory variables in candidates for liver transplantation

Abstract

Respiratory comorbidities are common in cirrhotic patients and may influence the decision for liver transplantation (LT). Our objective was to determine their prevalence and prognostic value. NYHA functional class (FC), 6-minute walk distance (6MWD), arterial blood gases, lung function tests, right heart catheterization and hepatopulmonary syndrome (HPS) screening were performed in 289 consecutive cirrhotic patients listed for LT between 02/2005 and 04/2008. The prognostic value of respiratory variables was analyzed over a follow-up period of 10 years. The mean age was 52±8 years (78% males, 72% Child-Pugh (CP) stage B or C). 36% were in NYHA-FC II or more, 47% had hypoxemia defined by O2 alveolo-arterial difference (AaDO2) >15 mmHg and 15% had obstructive ventilatory disorder defined by FEV-1/FVC<70%. The prevalence of hepatic hydrothorax (HH), HPS and portopulmonary hypertension (PoPH) was respectively 6.6%, 12.4% and 1.4%. 6MWD was positively correlated with hemoglobin (p<0.0001), FEV-1 (p=0.006), DLCO (p=0.03) and negatively with CP stage (p <0.001) and AaDO2 (p=0.006). Mortality on waiting list was 16.6%. In univariate analysis, low FVC and diagnosis of HH were associated with a higher risk of mortality on waiting list. 214 patients (74%) were transplanted. The overall survival after LT was 86%, 74% and 63% at 1, 5 and 10 years. Respiratory or hemodynamic variables were not correlated with post-LT mortality. Respiratory comorbidities are frequent in patients listing for LT and associated with an increased risk of mortality on waiting list without impact on post-transplant mortality.