Korean J Hepatol.  2002 Sep;8(3):271-276.

Prevalence and Risk Factors of Significant Intrapulmonary Shunt in Cirrhotic patients awaiting liver transplantation

• Lee JM
• Choi MS
• Lee SC
• Park SW
• Bae MH
• Lee JH
• Koh KC
• Paik SW
• Rhee PL
• Kim JJ
• Rhee JC

Abstract

BACKGROUNDS/AIMS: Hepatopulmonary syndrome is a condition of severe hypoxia with intrapulmonary shunt (IPS) in the setting of hepatic dysfunction. Liver transplantation has been suggested as a definite treatment for hepatopulmonary syndrome with reversal of IPS in some patients. Inconsistency of response and inability to predict reversibility, however, are significant problems. We performed this study to evaluate the prevalence of significant IPS in pretransplantation cirrhotic patients and to find any risk factors of IPS. METHODS: Fifty-seven patients (M:F = 38:19, median age 49 years (range 18 - 71)) with liver cirrhosis awaiting liver transplantation were serially included. Their IPS status was evaluated using contrast- enhanced echocardiography. Significant shunt was defined as a shunt of grade >or= 2. RESULTS: Significant IPS was detected in 30 (52.6%) among 57 patients. Significant shunt was found in 24 (63.2%) of 38 Child-Pugh class C patients and in 6 (31.6%) of 19 Child-Pugh class A or B patients (p < 0.05). No significant difference in prevalence of significant shunt was seen according to age, sex, presence or absence of hepatocellular carcinoma, ascites, hepatic encephalopathy, and gastroesophageal varix. CONCLUSION: Significant intrapulmonary shunt is a common finding in cirrhotic patients awaiting liver transplantation. Child-Pugh class C is the risk factor associated with high prevalence of significant shunt.

Keyword

Hepatopulmonary syndrome; Intrapulmonary shunt; Liver cirrhosis; Liver transplantation; Child-Pugh classification

MeSH Terms

Adolescent
Adult
Aged
Echocardiography
English Abstract
Female
Hepatopulmonary Syndrome/etiology
Human
Liver Cirrhosis/*physiopathology/surgery
*Liver Transplantation
Male
Middle Aged
*Pulmonary Circulation
Risk Factors