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. 2019 May;34(3):510-518.
doi: 10.3904/kjim.2017.152. Epub 2018 Mar 5.

Time-dependent reversal of significant intrapulmonary shunt after liver transplantation

Xin Jin  1 , Byung Joo Sun  1 , Jae-Kwan Song  1 , Jae-Hyung Roh  1 , Jeong Yoon Jang  1 , Dae-Hee Kim  1 , Young-Suk Lim  2 , Jong-Min Song  1 , Duk-Hyun Kang  1 , Sung Gyu Lee  3
Affiliations

Time-dependent reversal of significant intrapulmonary shunt after liver transplantation

Xin Jin et al. Korean J Intern Med. 2019 May.

Abstract

Background/aims: Although the association between intrapulmonary shunt (IPS) and liver cirrhosis is clear, data of repeated contrast echocardiography (CE) before and after liver transplantation (LT) to evaluate factors associated with IPS are limited.

Methods: Hand-agitated saline was used for CE and, by assessing left-chamber opacification, IPS was classified as grade 0 to 4. Grade 3/4 constituted significant IPS and hepatopulmonary syndrome (HPS) was defined as significant IPS with the arterial partial pressure of oxygen < 70 mmHg.

Results: Before LT, 253 patients underwent CE and the frequency of significant IPS and HPS were 44% (n = 112) and 7% (n = 17), respectively. Child-Pugh score (odds ratio [OR], 1.345; 95% confidence interval [CI], 1.090 to 1.660; p = 0.006) and arterial oxygen content (OR, 0.838; 95% CI, 0.708 to 0.991; p = 0.039) were independent determinants of significant IPS, whereas direct bilirubin (OR, 1.076; 95% CI, 1.012 to 1.144; p = 0.019) was the only variable associated with HPS. Among 153 patients who underwent successful LT, repeated CE was performed in 97 (63%), which showed significant reductions in IPS grade (from 2.6 ± 1.0 to 1.2 ± 1.3, p < 0.001) and the prevalence of significant IPS (from 56% to 20%, p = 0.038). After adjustment for pre-LT IPS grade, time from LT to repeated CE presented negative linear relationship with post-LT IPS grade (r 2 = 0.366, p < 0.001) and was the only determinant of post-LT IPS grade (OR, 1.009; 95% CI, 1.003 to 1.014; p = 0.004).

Conclusion: Repeated CE is useful to evaluate intrapulmonary vascular change before and after LT. Reversal of IPS after successful LT is time-dependent and follow-up duration should be considered for accurate assessment of IPS after LT.

Keywords: Echocardiography; Intrapulmonary shunt; Liver cirrhosis; Liver transplantation.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Representative echocardiographic images showing different intrapulmonary shunt severity on contrast-enhanced transthoracic echocardiography. LV, left ventricle; LA, left atrium.
Figure 2.
Figure 2.
Relationship between Child-Pugh score and intrapulmonary shunt (IPS) severity before liver transplantation.
Figure 3.
Figure 3.
Changes in intrapulmonary shunt grade before and after liver transplantation (LT).
Figure 4.
Figure 4.
Linear relationship between post-liver transplantation (LT) intrapulmonary shunt (IPS) grade and follow-up duration adjusted by the pre-LT IPS grade.
Figure 5.
Figure 5.
Impact of significant intrapulmonary shunt (IPS) on survival rate in patients (A) with and (B) without successful liver transplantation (LT).
See this image and copyright information in PMC

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