Gastroenterology
Volume 135, Issue 4 , Pages 1168-1175, October 2008

Impact of Hepatopulmonary Syndrome on Quality of Life and Survival in Liver Transplant Candidates

  • Michael B. Fallon

      Affiliations

    • Department of Medicine, University of Alabama, Birmingham, Alabama
    • Corresponding Author InformationAddress requests for reprints to: Michael B. Fallon, MD, Liver Center, University of Alabama at Birmingham, MCLM 287, 1918 University Boulevard, Birmingham, Alabama 35294-0005. fax: (205) 975-9777
    • ,
  • Michael J. Krowka

      Affiliations

    • Department of Medicine, Mayo Clinic, Rochester, Minnesota
    • ,
  • Robert S. Brown

      Affiliations

    • Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
    • ,
  • James F. Trotter

      Affiliations

    • Department of Medicine, University of Colorado, Denver, Colorado
    • ,
  • Steven Zacks

      Affiliations

    • Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
    • ,
  • Kari E. Roberts

      Affiliations

    • Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts
    • ,
  • Vijay H. Shah

      Affiliations

    • Department of Medicine, Mayo Clinic, Rochester, Minnesota
    • ,
  • Neil Kaplowitz

      Affiliations

    • Department of Medicine, University of Southern California, Los Angeles, California
    • ,
  • Lisa Forman

      Affiliations

    • Department of Medicine, University of Colorado, Denver, Colorado
    • ,
  • Keith Wille

      Affiliations

    • Department of Medicine, University of Alabama, Birmingham, Alabama
    • ,
  • Steven M. Kawut

      Affiliations

    • Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
    • Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
    • ,
  • Pulmonary Vascular Complications of Liver Disease Study Group

Received 5 March 2008; accepted 12 June 2008. published online 24 June 2008.

Background & Aims: Hepatopulmonary syndrome (HPS) affects 10%–30% of patients with cirrhosis and portal hypertension, but the impact on functional status, quality of life, and survival is poorly defined. We assessed the impact of HPS in patients evaluated for liver transplantation. Methods: We performed a prospective multicenter cohort study of patients being evaluated for liver transplantation in 7 academic centers in the United States. Patients with HPS (defined as an increased alveolar-arterial oxygen gradient with intrapulmonary vasodilation) were compared with those without HPS in terms of demographics and clinical variables. New York Heart Association functional class, quality of life, and survival were assessed. Results: Seventy-two patients with HPS and 146 patients without HPS were compared. There were no differences in age, sex, or etiology or severity of liver disease between the groups; however, patients with HPS were less likely to have a history of smoking (P = .03). Patients with HPS had worse New York Heart Association functional class (P = .005) and had significantly worse quality of life in certain domains compared with patients without HPS. In addition, patients with HPS also had a significantly increased risk of death compared with patients without HPS despite adjustment for age, sex, race/ethnicity, Model for End-Stage Liver Disease score, and liver transplantation (adjusted hazard ratio = 2.41; 95% confidence interval, 1.31–4.41; P = .005). Conclusions: HPS was associated with a significant increase in risk of death as well as worse functional status and quality of life in patients evaluated for liver transplantation.

Abbreviations used in this paper: CI, confidence interval, FEV1, forced expiratory volume in 1 second, FVC, forced vital capacity, HPS, hepatopulmonary syndrome, HR, hazard ratio, LDQOL, Liver Disease Quality of Life, MELD, Model for End-Stage Liver Disease, NYHA, New York Heart Association, SF-36, Short Form-36

 

 

Supported by National Institutes of Health grants DK064103, DK065958, RR00645, RR00585, RR00046, RR00032, and HL67771.

 The authors have no conflicts of interest to report.

 The Pulmonary Vascular Complications of Liver Disease Study Group also includes the following: Columbia University: Jenna Reinen, BA, Jeffrey Okun, BA, Sonja Olsen, MD, Debbie Rybak, BA, Daniel Rabinowitz, PhD, Lori Rosenthal, NP, Evelyn M. Horn, MD; Mayo Clinic: Linda Stadheim, RN, Russell Wiesner, MD; University of Alabama: Dottie Faulk, J. Stevenson Bynon, MD, Devin Eckhoff, MD, Harpreet Singh, Rajasekhar Tanakella, Raymond Benza, MD; University of Colorado: David Badesch, MD, Ted Perry; University of North Carolina: Carrie Nielsen, RN, Roshan Shrestha, MD; University of Pennsylvania: Vivek Ahya, MD, Harold Palevsky, MD, Rajender Reddy, MD, Michael Harhay, Sandra Kaplan, RN, Darren Taichman, MD, PhD; University of Southern California, James Knowles, MD, PhD.

PII: S0016-5085(08)01089-5

doi:10.1053/j.gastro.2008.06.038

Gastroenterology
Volume 135, Issue 4 , Pages 1168-1175, October 2008