The Effect of Orthotopic Liver Transplantation(OLT) On Hepatopulmonary Syndrome and Risk Factors Predicting the Prognosis After Operation.

Abstract

Objective To observe the effect of OLT on Hepatopulmonary syndrome (HPS), summarize the post operative complications, and investigate risk factors predicting the prognosis of OLT. Methods 26 cases of HPS and 30 cases of non-HPS underwent OLT and their data were analyzed. 5 other HPS patients were not performed OLT. The written informed consents of all patients were obtained and the ethical committee approval was received. Survival rate after OLT were compared and risk factors predicting the prognosis of OLT in HPS were researched by univariant and COX analysis. Results The incidence of HPS in OLT patients was 9.3% (26/279). Hypoxemia in HPS was obviously improved with a normalized shunt of 99mTc MAA in the lungs after OLT. The immediate postoperative survival rate (within 28 days after OLT) of HPS was 76.9% (20/26). The one year survival was 61.5% (16/26) and four-year survival was 57.7% (15/26), much higher than HPS patients without OLT (0), but significantly lower than the 5 year survival rate in non-HPS groups after OLT(80%). The peri-operative complications in HPS patients included: excessive bleeding, pulmonary infection, wound infection, stroke, hypernatremia, renal dysfunction and multiple organ dysfunction. By univariant analysis, shunt of 99MTC-labeled macro-aggregated albumin in lungs, PaO2, AaDO2 and PaO2/FiO2 in room air before operation were relative to the prognosis of peri-operative period and half a year outcome after OLT in HPS (P<0.05 ). Shunt of 99MTC-labeled macro-aggregated albumin in lungs (OR=1.189, P=0.062), AaDO2 in room air (OR=1.603, P=0.042) before OLT and mechanical ventilation time (OR=1.004, P=0.021) after OLT were independent risk factors predicting the prognosis of OLT in HPS by COX analysis. Shunt of 99MTC-labeled macro-aggregated albumin in lungs ≥28.38%, or PaO2≤56mmHg, or AaDO2 ≥55.48 before OLT predicted the poor outcome of OLT in HPS. The sensitivity were 83.3%, 85% and 83.3% respectively, and the specificity were 95.0%, 83.3% and 90.0% respectively. Conclusions Orthotopic liver transplantation was an effective treatment for HPS, but the morbidity and mortality of post-operative complications were still high. Shunt of 99MTC-labeled macro-aggregated albumin in lungs, AaDO2 in room air before OLT and mechanical ventilation time after OLT were independent risk factors for the prognosis of OLT in HPS.