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ICU and Hospital Outcomes in Patients with Hepatopulmonary Syndrome Undergoing Liver Transplantation

  • LIVER TRANSPLANTATION IN HEPATOPULMONARY SYNDROME
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Abstract

Purpose

There are limited data regarding hospital and intensive care unit (ICU) outcomes in patients with hepatopulmonary syndrome (HPS) following liver transplantation (LT).

Methods

Data were retrospectively collected from consecutive HPS adult patients who underwent LT and were immediately admitted to the ICU at three transplant centers with shared management protocols, from 2002 to 2018. Demographic, clinical, surgical, laboratory, and outcome data were extracted.

Results

We identified 137 patients (74 male, 54%), with a median age at LT of 58 years (IQR: 52–63). One hundred and 31 (95.6%) patients were admitted to the ICU on invasive mechanical ventilation (MV). The median time on invasive MV in the ICU was 12 hours (IQR: 5–28) and 97 patients (74%) were extubated within 24 hours of ICU admission. The median highest positive end expiratory pressure and fraction of inspired oxygen (FiO2) were 7 (IQR: 5–8) and 0.6 (IQR: 0.5–0.7), respectively. 7 patients (5%) developed severe post-transplant hypoxemia. Of all patients, 42 (30.4%) required vasopressors and the median ICU and hospital length of stay (LOS) were 3 (IQR: 1–5) and 10 (IQR: 7–20) days, respectively. The in-hospital mortality rate was 3.6% (5/137). HPS severity was not associated with hospital mortality.

Conclusion

Most HPS patients have short durations of MV, ICU, and hospital LOS post-LT. HPS severity does not impact hospital mortality.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ESLD:

End-stage liver disease

HPS:

Hepatopulmonary syndrome

LT:

Liver transplantation

MELD:

Model for end-stage liver disease

NAFLD:

Non-alcoholic fatty liver disease

Post-LT:

After liver transplantation

Pre-LT:

Before liver transplantation

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Acknowledgements

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Catarina Aragon Pinto, Vivek Iyer, Yahya A. Almodallal, Hasan Albitar, Hilary Dubrock, Hector Cajigas, Michael Krowka & Alice Gallo de Moraes

  2. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Julie K. Heimbach, Charles B. Rosen, Timucin Taner & Scott Nyberg

  3. Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Kimberly Watt

  4. Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA

    Hugo Vargas

  5. Division of Pulmonary and Critical Care Medicine,, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA

    Rodrigo Cartin-Ceba

  6. Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA

    Andrew P. Keaveny

Authors
  1. Catarina Aragon Pinto
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  2. Vivek Iyer
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  3. Yahya A. Almodallal
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  4. Hasan Albitar
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  5. Hilary Dubrock
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  6. Hector Cajigas
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  7. Julie K. Heimbach
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  8. Charles B. Rosen
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  9. Kimberly Watt
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  10. Timucin Taner
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  11. Scott Nyberg
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  12. Hugo Vargas
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  13. Rodrigo Cartin-Ceba
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  14. Andrew P. Keaveny
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  15. Michael Krowka
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  16. Alice Gallo de Moraes
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Contributions

CAP: conceptualization, data curation, methodology, formal analysis, original draft; VI: conceptualization, methodology, review and editing; YAA: data curation; HA, HD, HC, JKH, CBR, KW, TT, SN, HV, RCC, APK, MK: conceptualization, review and editing; AGM: conceptualization, data curation, methodology, formal analysis, original draft, review and editing

Corresponding author

Correspondence to Alice Gallo de Moraes.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Study was approved by the Mayo Clinic Institutional Review Board and all patients authorized the use of their medical records for research.

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All authors have seen and agree to the conditions outlined in the Authorship and Contributorship section of the Submission Guidelines, and have approved the final version of this manuscript.

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Aragon Pinto, C., Iyer, V., Almodallal, Y.A. et al. ICU and Hospital Outcomes in Patients with Hepatopulmonary Syndrome Undergoing Liver Transplantation. Lung 200, 5–10 (2022). https://doi.org/10.1007/s00408-021-00508-9

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  • DOI: https://doi.org/10.1007/s00408-021-00508-9

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