1. Abstract Category: Liver
Improved severe hepatopulmonary syndrome after liver transplantation (Case Report) Presenter : Dr. Mohammad Firooizifar, Fellowship in Anesthesia for Organ Transplantation, Consultant LITU Shiraz Transplant Research Center, Shiraz University of Medical Sciences
Abstract Category: Liver
Poster No. P47
Introduction
Results
Hepatopulmonary syndrome is a severe complication of liver cirrhosis, which is characterized by chronic hypoxia, intrapulmonary vascular dilatation and shunt. The prevalence of HPS varies widely between studies (5%-32% of patients) and likely reflects diverse patient populations and varying definitions of hypoxemia. HPS is associated with varying severities of hypoxemia and a room air upright PaO2_50mmHg is considered to be very severe hypoxemia. Liver transplantation is the only therapeutic cure for these patients. This case report describes a patient with typical findings of a severe Hepatopulmonary syndrome,, who had correction of HPS by liver transplantation.
The patient recovered effectively after liver transplantation. The partial pressure of arterial oxygen improved progressively during two week postoperative follow up period, (his PaO2 after discharge was 207 mmHg) and his dependency on oxygen was removed rapidly after about one month.
Conclusions
There are no effective medical therapies for severe Hepatopulmonary syndrome, and liver transplantation is the only consistent treatment for these patients. Prognosis of HPS patients who did not undergo liver transplantation showed significantly poor.
Many transplant centers have considered Hepatopulmonary syndrome as a contraindication to liver transplantation in past, however, it is now considered as an indication for liver transplantation because of, perioperative care, post operative ICU care and improvement in surgical techniques.
In this report, we presented a patient of severe Hepatopulmonary syndrome, who had typical findings of intrapulmonary shunt detected by echocardiography and with low PaO2, which was successfully treated during ICU course after liver transplantation.
Objectives
The patient was a 32-year-old male with diagnosis of auto immune hepatitis since 13 years ago. His Child-Turcotte-Pugh classification was C and MELD (Model of End-Stage Liver Disease) score was 22. He had been suffered from progressive liver failure with dyspnea, clubbing fingers, and cyanosis. Preoperative arterial blood gas analysis revealed hypoxia (arterial O2 tension of 52mmHg and O2 saturation of 83%) with a severe extra cardiac right-to-left shunt in echocardiography with agitated saline bubble, which suggested an intrapulmonary arteriovenous shunt.
References
Methods
Different strategies have been used for this patient : frequent body positioning (Trendelenburg positioning), fluid restriction with infused low dose Norepinephrine in first post-operative day and early extubation associated with immediate non-invasive ventilation and high-inspired fraction of oxygen, to avoid the harmful effects of mechanical ventilation.
Proposed Management Algorithm for Severe Hypoxemia After Liver Transplantation in the Hepatopulmonary Syndrome ,American ,Journal of Transplantation 2015
Portopulmonary hypertension and hepatopulmonary syndrome ,World J Gastroenterol 2014