Non-invasive assessment of intrapulmonary shunt and ventilation to perfusion ratio in children with hepatopulmonary syndrome before and after liver transplantation - 12/05/21
, Tassos Grammatikopoulos a, b , Anne Greenough c, d, e , Anil Dhawan a, b , Theodore Dassios c, e, f, ⁎ Abstract |
Objectives |
To use the oxyhaemoglobin dissociation curve (ODC) to non-invasively measure the ventilation perfusion ratio (VA/Q) and right-to-left intrapulmonary vascular shunt before and after liver transplantation (LT) in children with hepatopulmonary syndrome (HPS). To investigate whether the right-to-left shunt derived by ODC correlated with the shunt derived by technetium-99 labelled macroaggregated albumin lung perfusion scan (MAA).
Methods |
A retrospective cohort study at King's College Hospital NHS Foundation Trust, London, UK was performed between 1998 and 2016. The VA/Q and right-to-left shunt were non-invasively measured pre and post LT. The pre-LT right-to-left intrapulmonary shunt was also measured by MAA. The non-invasively derived pre-LT shunt was correlated with the shunt derived by MAA.
Results |
Fifteen children with HPS were studied with a median (IQR) age at LT of 8.8 (6.6–12.9) years. The median (IQR) pre-LT VA/Q [0.49 (0.42–0.65)] was lower compared to the post-LT VA/Q [0.61 (IQR 0.54–0.72), p = 0.012]. The median (IQR) pre-LT shunt was 19 (3–24) % which decreased to zero in all but one children post-LT, (p = 0.001). The MAA-derived shunt was significantly positively correlated with the ODC-derived shunt (r = 0.783, p = 0.001). The mean (SD) difference between shunt derived by ODC and shunt derived by MAA was 0.5 (7.2) %.
Conclusions |
Ventilation/perfusion impairment reverses but not completely resolves after liver transplantation in children with hepatopulmonary syndrome. The non-invasive method for estimating intrapulmonary shunting could be used as an alternative to the macroaggregated albumin scan in this population.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Hepatopulmonary syndrome (HPS) is a complication of chronic liver disease. |
• | Hypoxaemia in HPS occurs due to VA/Q mismatch and right-to-left shunting. |
• | We describe a novel method to measure shunt by the haemoglobin dissociation curve. |
• | VA/Q abnormalities reverse but not completely resolve post liver transplantation. . |
Keywords : Hepatopulmonary syndrome, Ventilation perfusion ratio, Intrapulmonary shunting
Abbreviations : AST, FIO2, Hb, HPS, INR, LT, MAA, ODC, SpO2, (VA/Q, WBC
Plan
Vol 180
Article 106372- avril 2021 Retour au numéro
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