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Arterial Oxygenation Associated With Portopulmonary Hypertension^*

^* From the Divisions of Pulmonary and Critical Care (Dr. Swanson), and Gastroenterology and Hepatology (Dr. Krowka), Mayo Clinic and Mayo Graduate School of Medicine, Rochester, MN.

Correspondence to: Michael J. Krowka, MD, FCCP, Mayo Clinic E18, 200 First St SW, Rochester, MN 55905; e-mail: krowka{at}mayo.edu

Study objectives: To characterize arterial oxygenation in patients referred to Mayo Clinic for liver transplantation with a diagnosis of portopulmonary hypertension (portoPH).

Design: Prospective study.

Setting: Liver transplantation program and pulmonary hypertension clinic in a tertiary referral center.

Participants: Twenty consecutive patients with abnormal pulmonary hemodynamics documented by right-heart catheterization (mean pulmonary artery pressure [MPAP] 25 mm Hg, pulmonary vascular resistance [PVR] 120 dyne·s·cm^-5, and pulmonary capillary wedge pressure [PCWP] 15 mm Hg). Liver transplant candidates with normal pulmonary hemodynamics via screening Doppler echocardiography (n = 40) served as control subjects. A subgroup of patients underwent postural and inspired 100% oxygen blood gas analysis, contrast echocardiography, and technetium-labeled macroaggregated albumin (^99mTcMAA) lung/brain scanning to identify and quantitate the degree of intracardiac or intrapulmonary shunting.

Measurements and results: portoPH was moderate to severe (MPAP > 35 mm Hg) in 18 of 20 patients (90%). Arterial-alveolar oxygen pressure gradient (P[A-a]O₂) was abnormal ( 20 mm Hg) in 16 of 20 patients (80%). PaO₂ was abnormal ( 70 mm Hg) in 3 of 20 patients (15%). Pa0₂ was significantly less and P(A-a)O₂ was significantly greater compared to control subjects (p < 0.001). All patients had normal ^99mTcMAA brain uptake (< 6%) and negative transthoracic contrast echocardiographic findings. No significant correlations were found between oxygenation and hemodynamic variables (MPAP, PVR, PVR index, and transpulmonary gradient).

Conclusions: Arterial oxygenation associated with portoPH was frequently abnormal and significantly worse when compared to patients with normal pulmonary hemodynamics by Doppler echocardiography. Hypoxemia, as measured by PaO₂ and P(A-a)O₂, was usually mild even in the setting of moderate-to-severe portoPH.

Key Words: liver cirrhosis • lung scanning • portal hypertension • pulmonary hemodynamics • pulmonary hypertension • shunt

This article has been cited by other articles:

				R. Rodriguez-Roisin, M.J. Krowka, Ph. Herve, M.B. Fallon, and on behalf of the ERS Task Force Pulmonary-Hepatic Pulmonary-Hepatic vascular Disorders (PHD) Eur. Respir. J., November 1, 2004; 24(5): 861 - 880. [Full Text] [PDF]