P-44 OUTCOMES AND MORTALITY OF PATIENTS WITH HEPATOPULMONARY SYNDROME AT A QUATERNARY LIVER TRANSPLANT CENTER

Introduction and Objectives

Hepatopulmonary syndrome (HPS) is diagnosed in 5-32% of cirrhotic patients on the waitlist (WL) for liver transplantation (LT), which improves survival and hypoxemia. This study aimed to retrospectively analyze clinical, laboratory and radiological findings of HPS patients in transplantation WL, describing clinical outcomes.

Materials and Methods

HPS patients prioritized for LT [partial pressure of oxygen (PaO2)60mmHg] were included. Patients with insufficient data were excluded. Data collection is in progress, final results will be available at presentation.

Results

24 patients were included; 54.2% female, mean age 49.5±15.5y. The most common cirrhosis’ etiologies were viral hepatitis (25.1%) and cryptogenic (16.7%). Diabetes (33.3%), hypertension (25%) and coronary disease (16.7%) were frequent. 5 patients had tobacco/smoke exposure. Mean MELD-Na at HPS diagnosis was 15.3±4.14. The most frequent cirrhosis’ complications were hepatic encephalopathy (37.5%) and ascites (33.3%). Dyspnoea (91.7%) and digital clubbing (21.8%) were common findings at physical examination. The most prevalent imaging findings were pulmonary infiltrate (25%) and atelectasis (12.5%). Mean PaO2 at HPS diagnosis was 52.9±6.5mmHg with oxygen saturation of 85.9±5.3%. 20 patients were submitted to LT. Mean time between diagnosis and LT was 292±192d. 4 patients used garlic capsules, 12 used propranolol. Pre-transplant, PaO2 was 60.3±13.3 mmHg. 12 patients died, 9 were transplanted (at mean time of 193.6 ± 208.5d post-procedure). Non-transplanted patients had 75% mortality compared to 45% in LT group. Post-LT, PaO2 improved to 60±19.2 at 3m, 68.5±23.9 at 6m and 74.6±12.5 after 1y. The median PaO2 at diagnosis was lower in deceased patients (p=0.026). There was no difference in mortality according to sex, comorbidities, cirrhosis etiology and complications (p>0.05) or MELD-Na, (p=0.812). The mean time between diagnosis and LT had no impact in survival (p=0.16).

Conclusions

HPS is associated with a mortality of 75% without LT; LT is the ideal treatment, improving oxygenation and reducing mortality to 45%.