Prevalence and Risk Factors of Significant Intrapulmonary Shunt in Cirrhotic patients awaiting liver transplantation

Korean J Hepatol > Volume 8(3); 2002 > Article

The Korean Journal of Hepatology 2002;8(3): 271-276.

원저 : 간이식 대기 중인 간경변 환자에서 의미 있는 폐내 단락의 빈도와 이와 연관된 인자에 관한 연구 ( Original Articles : Prevalence and Risk Factors of Significant Intrapulmonary Shunt in Cirrhotic patients awaiting liver transplantation )

Prevalence and Risk Factors of Significant Intrapulmonary Shunt in Cirrhotic patients awaiting liver transplantation

Ji Min Lee,Moon Seok Choi,Sang Chol Lee,Seung Woo Park,Mun Hee Bae,Joon Hyeok Lee,Kwang Cheol Koh,Seung Woon Paik,Poong Lyul Rhee,Jae Jun Kim,Jong Chul Rhee

Division of Gastroenterology and Gastrointestinal Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

ABSTRACT

Backgrounds
/Aims: Hepatopulmonary syndrome is a condition of severe hypoxia with intrapulmonary shunt (IPS) in the setting of hepatic dysfunction. Liver transplantation has been suggested as a definite treatment for hepatopulmonary syndrome with reversal of IPS in some patients. Inconsistency of response and inability to predict reversibility, however, are significant problems. We performed this study to evaluate the prevalence of significant IPS in pretransplantation cirrhotic patients and to find any risk factors of IPS. Methods: Fifty-seven patients (M:F = 38:19, median age 49 years (range 18 - 71)) with liver cirrhosis awaiting liver transplantation were serially included. Their IPS status was evaluated using contrastenhanced echocardiography. Significant shunt was defined as a shunt of grade ≥2. Results: Significant IPS was detected in 30 (52.6%) among 57 patients. Significant shunt was found in 24 (63.2%) of 38 Child-Pugh class C patients and in 6 (31.6%) of 19 Child-Pugh class A or B patients (p<0.05). No significant difference in prevalence of significant shunt was seen according to age, sex, presence or absence of hepatocellular carcinoma, ascites, hepatic encephalopathy, and gastroesophageal varix. Conclusion: Significant intrapulmonary shunt is a common finding in cirrhotic patients awaiting liver transplantation. Child-Pugh class C is the risk factor associated with high prevalence of significant shunt. (Korean J Hepatol 2002;8:271-276)

KeyWords: Hepatopulmonary syndrome, Intrapulmonary shunt, Liver cirrhosis, Liver transplantation, Child-Pugh classification