Lai Yin, Hung Hao-Chien, Lee Jin-Chiao, Wang Yu-Chao, Cheng Chih-Hsien, Wu Tsung-Han, Wu Ting-Jung, Chou Hong-Shiue, Chan Kun-Ming, Lee Wei-Chen, Lee Chen-Fang
Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Chang-Gung University College of Medicine, Taoyuan, Taiwan.
Ann Transplant. 2024 Dec 3;29:e945297. doi: 10.12659/AOT.945297.
BACKGROUND Liver transplantation (LT) is the preferred treatment for patients with cirrhosis who have hepatopulmonary syndrome (HPS). However, the effect of HPS on LT remains controversial. We assessed the correlation between HPS severity and LT survival and compared the incidence of postoperative complications between patients with and without HPS undergoing LT. MATERIAL AND METHODS We retrospectively reviewed the recipients who received living-donor LT in our institute between January 2016 and July 2019. Patients with HPS (HPS group) and patients without HPS (non-HPS group) were included in our study. HPS is defined as a defect in arterial oxygenation caused by the presence of intrapulmonary vascular dilatations, which is found by transthoracic echocardiography with pre-existing liver cirrhosis. HPS severity was graded according to the value of partial pressure of arterial oxygen. The demographic characteristics and clinical outcomes between the HPS and non-HPS groups were compared. RESULTS A total of 181 patients were enrolled. Among them, 104 patients (57.5%) had HPS. The mean overall survival of HPS and non-HPS groups was 69.82±3.1 vs 63.36±3.8 months, with no significant difference (P=0.332). The overall survival between different degrees of HPS was also compared, and showed no significant difference (P=0.466). The HPS group had a higher incidence of delayed extubation (22.1% vs 10.4%, P=0.028) and chest pigtail catheter insertion (16.3% vs 10.4%, P=0.012). Nevertheless, it did not lead to a longer Intensive Care Unit/hospital stay or higher risk of short-term mortality. CONCLUSIONS Patients with HPS tend to have more post-LT pulmonary complications, but the overall survival is not adversely influenced, regardless of the severity of HPS.
背景 肝移植（LT）是肝硬化合并肝肺综合征（HPS）患者的首选治疗方法。然而，HPS对LT的影响仍存在争议。我们评估了HPS严重程度与LT生存率之间的相关性，并比较了LT患者中有无HPS患者的术后并发症发生率。材料与方法 我们回顾性分析了2016年1月至2019年7月在我院接受活体肝移植的受者。本研究纳入了HPS患者（HPS组）和无HPS患者（非HPS组）。HPS定义为存在肺内血管扩张导致的动脉氧合缺陷，通过经胸超声心动图在已存在肝硬化的情况下发现。根据动脉血氧分压值对HPS严重程度进行分级。比较了HPS组和非HPS组的人口统计学特征和临床结局。结果 共纳入181例患者。其中，104例患者（57.5%）患有HPS。HPS组和非HPS组的平均总生存期分别为69.82±3.1个月和63.36±3.8个月，无显著差异（P=0.332）。还比较了不同程度HPS之间的总生存期，无显著差异（P=0.466）。HPS组延迟拔管发生率较高（22.1%对10.4%，P=0.028）和胸腔置管率较高（16.3%对10.4%，P=0.012）。然而，这并未导致重症监护病房/住院时间延长或短期死亡风险增加。结论 HPS患者LT后肺部并发症往往较多，但无论HPS严重程度如何，总体生存率均未受到不利影响。
