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Less room-air oxygenation in hepatopulmonary syndrome patients increased post-transplant mortality

Survival rates among patients with hepatopulmonary syndrome and hypoxemia after transplantation were lower compared with patients with high partial pressure of oxygen in arterial blood levels before transplantation, according to recent study results.

Researchers analyzed data from the United Network for Organ Sharing of patients with hepatopulmonary syndrome (HPS) and on the liver transplant wait list to determine the effects of room-air oxygenation on pre and post-transplantation outcomes. Between 2002 and 2012, 1,075 wait list candidates submitted at least one exception application. Of those, 90.5% had one approved and were placed in the study’s HPS cohort. The non-HPS cohort included candidates who registered for their first transplantation on or after Feb. 27, 2002.

Wait list candidates with a partial pressure of oxygen in arterial blood (PaO₂) of less than 60 mm Hg were eligible for exception points to increase wait list priority. The transplant patients with severe hypoxemia had increased risk for mortality after liver transplantation. HPS patients had lower Model for End-Stage Liver Disease (MELD) scores at listing and non-HPS patients were more likely to experience hepatic decompensation before wait listing. Researchers observed no association between oxygenation and wait list mortality among patients with HPS exception points.

Unadjusted rates of 3-year post-transplantation survival were 84% for patients with PaO₂ between 44.1 mm Hg and 54 mm Hg vs. 68% in patients with PaO₂ of 44 mm Hg or lower. In multivariate analysis, transplant recipients with PaO₂ of no more than 44 mm Hg showed increases of post-transplantation mortality (HR=1.58; 95% CI, 1.15-2.18), compared with patients with the greater PaO₂. Overall mortality was lower among wait list patients with HPS exception points than those without (HR=0.82; 95% CI, 0.7-0.96).

“Our observation that transplant recipients with HPS and marked hypoxemia have worse post-transplantation survival refutes recent reports and demonstrates an association between pre-transplantation room-air oxygenation and post-transplantation mortality,” the researchers concluded.

Disclosure: The researchers report no relevant financial disclosures.