Sustained low diffusing capacity in hepatopulmonary syndrome after liver transplantation

Table 1 Physical and clinical characteristics of patients with and without hepatopulmonary syndrome (HPS)

Characteristics	HPS	Non-HPS
Patients (n)	6	24
Gender (F/M)	2/4	9/15
Age (yr)	43 ± 6	54 ± 2
Smoking Habits (n)
Smokers Ex-smokers	1 2	5 5
Etiology (n)
Hepatitis C	3	12
Alcohol	1	4
Idiopathic	0	4
Other	2	4
Child-Pugh, n (%)
A	1 (17)	3 (13)
B	4 (66)	13 (54)
C	1 (17)	8 (33)
Gastrointestinal bleeding, n (%)	4 (66)	10 (42)
Ascites, n (%)	3 (50)	18 (75)
Cutaneous spider naevi, n (%)	6 (100)	17 (71)
Concomitant respiratory Symptoms, n (%)
Digital clubbing	4 (66)	2 (8)a
Dyspnea	6 (100)	3 (12)a
Cyanosis	2 (33)	0 (0)a

^aP < 0.05 vs non-HPS.

Table 2 Lung function test and blood gas analysis before and after liver transplantation (LT) (mean ± SE)

	HPS1			Non-HPS1
Parameter	Pre-LT	Mid-term Post-LT	Long-term Post-LT	Pre-LT	Mid-term Post-LT
FEV12 (% pred)	89 ± 7	92 ± 8	87 ± 9	90 ± 4	89 ± 4
FVC 3 (% pred)	97 ± 6	100 ± 7	93 ± 11	89 ± 3	88 ± 3
FEV12/FVC3 4 (%)	72 ± 4	77 ± 5	74 ± 5	76 ± 2	76 ± 2
TLC4 (% pred)	100 ± 7	100 ± 9	99 ± 9	96 ± 2	93 ± 18
DLCO5 (mL/min/mmHg)	16.8 ± 3.4c	16.6 ± 3.5	16.9 ± 3.3	23.1 ± 2.1	20.7 ± 3.5
DLCO5 (% pred)	54 ± 9c	53 ± 8	56 ± 7	85 ± 3	79 ± 3
KCO6 (%pred)	59 ± 10c	54 ± 6	60 ± 7	91 ± 3	86 ± 4
VE7 (l/min)	10.3 ± 1.2	7.4 ± 0.4a	na13	10.3 ± 1.0	8.4 ± 0.6
VO28 (mL/min)	263.7±22.8	247.0 ± 26.2a	na13	270.3 ± 17.6	254.3 ± 13.2
Hemoglobin (g/L)	111 ± 22	121 ± 20	134 ± 21	104 ± 18	114 ± 16
PHa9	7.45 ± 0.02	7.39 ± 0.01a	7.42 ± 0.01	7.47 ± 0.01	7.41 ± 0.01a
PaO210 (mmHg)	71 ± 8c	91 ± 3a	87 ± 5a	94 ± 4	94 ± 2
PaCO211 (mmHg)	28 ± 2	36 ± 1a	34 ± 0a	31 ± 1	35 ± 1a
AaPO212 (mmHg)	43 ± 10c	14 ± 3a	23 ± 5a	19 ± 3	14 ± 2

¹Hepatopulmonary syndrome;

²Forced expiratory volume at 1 s;

³Forced vital capacity;

⁴Total lung capacity;

⁵Single-breath carbon monoxide diffusing capacity;

⁶carbon monoxide diffusing capacity normalized per liter alveolar volume;

⁷Minute ventilation;

⁸Oxygen uptake;

⁹Arterial pH;

¹⁰Partial pressure of arterial oxygen;

¹¹Partial pressure of arterial carbon dioxide;

¹²Alveolar to arterial oxygen partial pressure gradient;

¹³Not available.

^aP < 0.05 vs pre-LT;

^cP < 0.05 vs non-HPS.

Table 3 Individual lung function test before and after liver transplantation (LT) in hepatopulmonary syndrome patients (% pred)

Pre-LT							Mid-term post-LT						Long-Term Post-LT
Patients No.	1	2	3	4 2	5 1	6 2	1	2	3	4	5	6	1	2	3	4	5	6
FEV1	106	110	77	90	71	80	106	120	74	83	96	81	102	123	76	71	66	87
FVC	99	116	77	106	87	97	99	126	64	100	83	93	99	131	70	106	66	87
FEV1/FVC	84	76	81	65	62	61	81	78	94	63	80	65	80	76	89	52	75	74
TLC	93	118	70	117	96	104	92	125	69	122	88	102	92	138	68	114	85	96
DLCO	34	70	24	43	77	78	47	77	29	39	71	58	46	85	34	46	57	69

¹Smoker;

²Ex-smoker. For other abbreviations see Table 2.

Table 4 Ventilation-perfusion distributions in patients with hepatopulmonary syndrome before and after liver transplantation (LT) (mean ± SE)

	Pre-LT	Post-LT
Shunt1, % QT2	7.8 ± 3.3	0.6 ± 0.1a
Low VA/Q mode3, % of QT	4.1 ± 2.1	0.0 ± 0.0a
Mean Q4	0.85 ± 0.13	0.84 ± 0.04
Log SDQ5	0.95 ± 0.17	0.49 ± 0.08a
Mean V6	1.50 ± 0.25	1.11 ± 0.15
Log SDV7	0.64 ± 0.04	0.47 ± 0.07a
DISP R-E*8	11 ± 2	4 ± 1a
Dead space, %	18.8 ± 3.9	19.3 ± 4.6
Pred-meas PaO29, mmHg	6 ± 4	7 ± 3

¹Percentage of blood flow to unventilated units (V_A/Q < 0.005) (normal, 0% of Q_T);

²Cardiac output;

³Perfusion to units with V_A/Q ratios between 0.005 and 0.1 (normal, 0% of Q_T);

⁴Mean V_A/Q of the perfusion distribution;

⁵Dispersion of blood flow distribution (normal < 0.60);

⁶Mean V_A/Q of the ventilation distribution;

⁷Dispersion of ventilation distribution (normal < 0.65);

⁸The difference among measured retentions and excretions of the inert gases corrected for the excretion of acetone (normal < 3.0 );

⁹Predicted PaO₂ (by MIGET)-actual PaO₂ (measured).

^aP < 0.05 vs pre-LT.