Pulmonary evaluation in pediatric liver transplant candidates

Liver transplantation (LT) maybe complicated by pulmonary problems. This study aimed to evaluate pulmonary function and gas exchange abnormalities in pediatric patients listing for LT.

In total, 79 pediatric patients with advanced liver disease were included in the study. Pulmonary function test, contrast echocardiography and arterial blood gases analyses and chest radiography were performed for all the patients. Patients with and without hepatopulmonary syndrome (HPS) as well as patients with and without severe hypoxemia (partial pressure of arterial oxygen, PaO(2)<60 mmHg) were compared regarding clinical and paraclinical characteristics.

The most common causes for liver disease were cryptogenic cirrhosis, biliary atresia and autoimmune cirrhosis. Clubbing (n=27) and cyanosis (n=9) were the most common abnormalities in physical exam. Nine patients (11.4%) were found to have HPS. PaO(2) was 52.9 ± 10.4 mmHg in HPS patients while it was 73.7 ± 28 mmHg in non-HPS patients (p=0.03). Twenty eight patients had severe hypoxemia. Partial pressure of arterial carbon dioxide (PaCO(2)) was higher among patients with severe hypoxemia (p=0.001).

Pulmonary evaluation must be performed in all pediatric patients before LT. HPS is not so common among pediatric patients while hypoxemic patients may include a larger proportion of pediatric patients listing for LT.