Sustained low diffusing capacity in hepatopulmonary syndrome after liver transplantation

作     者：Graciela Martínez-Pallí Federico P Gómez Joan A Barberà Miquel Navasa Josep Roca Robert Rodríguez-Roisin Felip Burgos Conchi Gistau 

作者机构：Serveis de Pneumologia Anestesiologia and Hepatologia. Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic Universitat de Barcelona Barcelona Spain Serveis de Pneumologia Anestesiologia and Hepatologia. Institut d’Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic Universitat de Barcelona Barcelona Spain 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2006年第12卷第36期

页      面：5878-5883页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：Supported by Red Respira-ISCIII-RTIC-03/11 and Generalitat de Catalunya  No. 2005SGR-00822 

主　　题：容量 肝移植 一氧化碳 肺交换 

摘      要：AIM: To study the presence of sustained low diffusing capacity (DLCO) after liver transplantation (LT) in patients with hepatopulmonary syndrome (HPS).METHODS: Six patients with mild-to-severe HPS and 24 without HPS who underwent LT were prospectively followed before and after LT at mid-term (median, 15 mo). HPS patients were also assessed at long-tem (median, 86 mo).RESULTS: Before LT, HPS patients showed lower PaO2 (71 ± 8 mmHg), higher AaPO2 (43 ± 10 mmHg) and lower DLCO (54% ± 9% predicted), due to a combination of moderate-to-severe ventilation-perfusion (VA/Q) imbalance, mild shunt and diffusion limitation, than non-HPS patients (94 ± 4 mmHg and 19 ± 3 mmHg, and 85% ± 3% predicted, respectively) (P 0.05 each). Seven non-HPS patients had also reduced DLCO (70% ± 4% predicted).At mid- and long-term after LT, compared to pre-LT, HPS patients normalized PaO2 (91 ± 3 mmHg and 87 ± 5 mmHg), AaPO2 (14 ± 3 mmHg and 23 ± 5 mmHg) and all VA/Q descriptors (P 0.05 each) without changes in DLCO (53% ± 8% and 56% ± 7% predicted, respectively). Post-LT DLCO in non-HPS patients with pre-LT low DLCO was unchanged (75% ± 6% predicted).CONCLUSION: While complete VA/Q resolution in HPS indicates a reversible functional disturbance, sustained low DLCO after LT also present in some non-HPS patients, points to persistence of sub-clinical liver-induced pulmonary vascular changes.