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* From the Divisions of Pulmonary and Critical Care (Dr. Krowka) and Gastroenterology and Hepatology (Drs. Krowka, Parayko, and Wiesner), and the Departments of Diagnostic Radiology (Dr. Wiseman) and Health Sciences Research (Dr. Therneau), Mayo Clinic, Rochester, MN, and the Department of Diagnostic Radiology (Dr. Burnett) and the Division of Gastroenterology (Dr. Spivey), Mayo Clinic, Jacksonville, FL.
Correspondence to: Michael J. Krowka, MD, FCCP, Mayo Clinic, 200 1st St SW, Rochester, MN; e-mail: krowka{at}mayo.edu
Background: Because of the spectrum of intrapulmonary vascular dilation that characterizes hepatopulmonary syndrome (HPS), PaO2 while breathing 100% oxygen varies. Abnormal extrapulmonary uptake of 99mTc macroaggregated albumin (MAA) after lung perfusion is common.
Goal: To describe relationships between (1) severity of liver disease measured by the Child-Pugh (CP) classification; (2) PaO2 while breathing room air (RA) and 100% oxygen on 100% oxygen; and (3) extrapulmonary (brain) uptake of 99mTc MAA after lung scanning.
Methods and patients: We prospectively measured PaO2 on RA, PaO2 on 100% oxygen, and brain uptake after lung perfusion of 99mTc MAA in 25 consecutive HPS patients.
Results: Mean PaO2
on RA, PaO2 on 100% oxygen,
PaCO2 on RA, and 99mTc MAA brain
uptake were similar when categorized by CP classification. Brain uptake
was abnormal (
6%) in 24 patients (96%). Brain uptake was
29 ± 20% (mean ± SD) and correlated inversely with
PaO2 on RA (r = -0.57;
p < 0.05) and PaO2 on 100% oxygen
(r = -0.41; p < 0.05). Seven patients (28%) had
additional nonvascular pulmonary abnormalities and lower
PaO2 on 100% oxygen (215 ± 133 mm Hg vs
391 ± 137 mm Hg; p < 0.007). Eight patients (32%) died.
Mortality in patients without coexistent pulmonary abnormalities was
associated with greater brain uptake of 99mTc MAA
(48 ± 18% vs 25 ± 20%; p < 0.04) and lower
PaO2 on RA (40 ± 7 mm Hg vs 57 ± 11 mm
Hg; p < 0.001).
Conclusion: The degree of hypoxemia associated with HPS was not related to the CP severity of liver disease. HPS patients with additional nonvascular pulmonary abnormalities exhibited lower PaO2 on 100% oxygen. Mortality was associated with lower PaO2 on RA, and with greater brain uptake of 99mTc MAA.
Key Words: cirrhosis • hypoxemia • intrapulmonary shunt • liver transplantation • lung scanning
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