Current status of hepatopulmonary syndrome in liver transplantation in Japan: a Japanese multicenter analysis

Background Hepatopulmonary syndrome (HPS) negatively affects the outcomes of deceased donor liver transplantation (LT). Methods We retrospectively reviewed the clinical records of patients with HPS who underwent LT and studied the impact of risk factors on clinical outcomes to determine strategies to overcome complications. Patients with symptoms of hypo‐oxygenemia and a shunt ratio >15% on 99mTc‐MAA lung perfusion scintigraphy were defined as having HPS. Results Forty‐eight patients in 10 centers were enrolled. Diseases included biliary atresia, liver cirrhosis, non‐alcoholic steatohepatitis, congenital hepatic fibrosis, and others. The length of ICU stay was 2–170 days. The respirator was used for 41.6% of patients on post‐operative day (POD) 3 and 20.8% on POD 14. The patient survival rate was 87% at 1 year and 82% at 5 years. The causes of hospital mortality were sepsis, thrombotic microangiopathy, intracranial bleeding, pulmonary fibrosis, and transplant rejection. An amount of shunt ratio prior to LT was a significant risk factor for hospital mortality. Hypoxia from POD 3 to POD 14 was a risk factor for biliary stenosis. The shunt ratio of all surviving patients significantly improved. Conclusion Although LT is feasible for patients with HPS, early transplantation and avoiding hypo‐oxygenemia immediately after transplantation are important. Highlight Kotera and colleagues describe the current status of hepatopulmonary syndrome in liver transplantation in Japan. The pre‐transplantation shunt ratio was a risk factor for hospital mortality, and hypoxia from postoperative days 3 to 14 was a risk factor for biliary stenosis. The shunt ratios of all surviving patients significantly improved.