Krowka Michael J, Mandell M Susan, Ramsay Michael A E, Kawut Steve M, Fallon Michael B, Manzarbeitia Cosme, Pardo Manuel, Marotta Paul, Uemoto Shinji, Stoffel Markus P, Benson Joanne T
Mayo Clinic, Rochester, Minnesota 55905, USA.
Liver Transpl. 2004 Feb;10(2):174-82. doi: 10.1002/lt.20016.
Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PortoPH) are pulmonary vascular consequences of advanced liver disease associated with significant mortality after orthotopic liver transplantation (OLT). Data from 10 liver transplant centers were collected from 1996 to 2001 that characterized the outcome of patients with either HPS (n = 40) or PortoPH (n = 66) referred for OLT. Key variables (PaO2 for HPS, mean pulmonary artery pressure [MPAP], pulmonary vascular resistance [PVR], and cardiac output [CO] for PortoPH) were analyzed with respect to 3 definitive outcomes (those denied OLT, transplant hospitalization survivors, and transplant hospitalization nonsurvivors). OLT was denied in 8 of 40 patients (20%) with HPS and 30 of 66 patients (45%) with PortoPH. Patients with HPS who were denied OLT had significantly worse PaO2 compared with patients who underwent transplantation (47 vs. 52 mm Hg, P <.005). Transplant hospitalization survival was associated with higher pre-OLT PaO2 (55 vs. 37 mm Hg; P <.005). MPAP was significantly higher (53 vs. 45 mm Hg; P <.015) and PVR was significantly worse (614 vs. 335 dynes. s. cm(-5); P <.05) in patients with PortoPH who were denied OLT compared with patients who underwent transplantation. Transplant hospitalization mortality was 16% (5/32) in patients with HPS and 36% (13/36) in patients with PortoPH. All of the deaths in patients with PortoPH occurred within 18 days of OLT; 5 of the 13 deaths in patients with PortoPH occurred intraoperatively. We concluded that patients with HPS (based on a combination of low PaO2 and nonpulmonary factors) and patients with PortoPH (based on pulmonary hemodynamics) were frequently denied OLT because of pre-OLT test results and comorbidities. For patients who subsequently underwent OLT, transplant hospitalization mortality remained significant for both those with HPS (16%) and PortoPH (36%).
肝肺综合征（HPS）和门脉性肺动脉高压（PortoPH）是晚期肝病的肺血管并发症，与原位肝移植（OLT）后的高死亡率相关。收集了1996年至2001年期间来自10个肝移植中心的数据，这些数据描述了因OLT而转诊的HPS患者（n = 40）或PortoPH患者（n = 66）的预后情况。针对3种明确的结局（被拒绝进行OLT的患者、移植住院存活者以及移植住院非存活者），分析了关键变量（HPS患者的动脉血氧分压[PaO2]，PortoPH患者的平均肺动脉压[MPAP]、肺血管阻力[PVR]和心输出量[CO]）。40例HPS患者中有8例（20%）被拒绝进行OLT，66例PortoPH患者中有30例（45%）被拒绝。与接受移植的患者相比，被拒绝进行OLT的HPS患者的PaO2显著更低（47 vs. 52 mmHg，P <.005）。移植住院存活与OLT前较高的PaO2相关（55 vs. 37 mmHg；P <.005）。与接受移植的患者相比，被拒绝进行OLT的PortoPH患者的MPAP显著更高（53 vs. 45 mmHg；P <.015），PVR显著更差（614 vs. 335达因·秒·厘米⁻⁵；P <.05）。HPS患者的移植住院死亡率为16%（5/32），PortoPH患者为36%（13/36）。PortoPH患者的所有死亡均发生在OLT后的18天内；PortoPH患者的13例死亡中有5例发生在手术过程中。我们得出结论，HPS患者（基于低PaO2和非肺部因素的综合情况）和PortoPH患者（基于肺血流动力学）由于OLT前的检查结果和合并症而经常被拒绝进行OLT。对于随后接受OLT的患者，HPS患者（16%）和PortoPH患者（36%）的移植住院死亡率仍然很高。
