Prevalence and predictors of hepatopulmonary syndrome in liver transplant candidates

Background: Hepatopulmonary syndrome (HPS) is an independent predictor of survival after liver transplantation. Although the prevalence of chronic liver diseases is high in Egypt, the frequency of HPS among liver transplant candidates (LTC) is unknown. Aim: To assess the frequency of HPS and factors predictive of diagnosis of HPS in patients with end-stage liver diseases who are LTC. Methods: A cross sectional study of patients with end stage liver diseases who are LTC. Patients were subjected to clinical examination, laboratory investigations, arterial blood gas (ABG) measurement, pulmonary function tests, upper gastrointestinal endoscopy, and transthoracic contrast enhanced echocardiography (TCEE). The severity of liver disease was assessed by Model for end-stage liver disease (MELD) score. The diagnostic criteria for HPS were intrapulmonary vascular dilatation (IPVD) documented by TCEE, and alveolar-arterial oxygen gradient (A-aDO2) ⩾15 mmHg. Results: Eighty-four LTC patients were enrolled in the study. Sixteen patients (19%) fulfilled the criteria for diagnosis of HPS. Patients with HPS showed older ages, longer duration of liver diseases which were more severe (MELD score). Dyspnoea, cyanosis, clubbing, platypnoea, spider naevi and features of portal hypertension were significantly more common in the HPS group. In the recumbent position; patients with HPS had a significantly lower PaO2 and larger A-aDO2 compared to those without HPS. Patients with HPS showed a further fall in their PaO2 on sitting up (orthodeoxia). Conclusions: The prevalence of HPS among the studied group of Egyptian liver transplant candidates is 19%. Cyanosis, clubbing, spider naevi and platypnoea–orthodeoxia are suggestive indicators of HPS