Clinical evolution of pediatric patients with hepatopulmonary syndrome undergoing liver transplantation

Introduction: hepatopulmonary Syndrome contributes to increased morbidity in cirrhotic patients, and liver transplantation is currently the recognized curative treatment. Considering the importance of reducing mortality and morbidity in this group, the objective is to analyze the prevalence of postoperative complications in patients with hepatopulmonary syndrome. Objective: our study aims to expand knowledge about how hepatopulmonary syndrome influences the postoperative period of these pediatric patients. Methods: aretrospective analysis was conducted on pediatric patients (children and adolescents up to 18 years old) who underwent liver transplantation at a quaternary hospital between May 2018 and December 2023. Out of 295 pediatric transplants during the evaluated period, 18 were excluded due to retransplantation. Among the remaining 277 cases, 16 (5,77%) had confirmed Hepatopulmonary Syndrome through arterial blood gas analysis or echocardiogram with microbubble study. For patients with Hepatopulmonary Syndrome, were evaluated pre-transplant oxygen arterial pressure level, home oxygen therapy dependency before transplantation, intensive care unit stay duration, hospitalization duration, incidence of vascular and biliary complications, and mortality. Data was analyzed with the chi-square test with Yates correction and considered significant at p< .05. Results: among 3 patients dependent on oxygen before transplantation, one was documented oxygen-free within 3 months post-surgery. Arterial thrombosis was identified in 25% of patients, Portal vein thrombosis in 18,75% and biliary complications occurred in 50% of patients. All these complications were more prevalent in patients with, than without Hepatopulmonary Syndrome (p = 0.00019 for biliary complications, p=0.052 for arterial and = 0.01 for portal complications). The lethality was 37,5%, and 18,7% among those without Hepatopulmonary Syndrome (p> 0.05). Conclusions: pediatric patients with Hepatopulmonary Syndrome undergoing liver transplantation demonstrated a higher incidence of postoperative complications (specifically biliary complications and portal vein thrombosis) when compared with transplant patients without Hepatopulmonary Syndrome.