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Updated: Oct 25, 2025
Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure
Published on: September 13, 2014
Improved survival in children with HPS: Experience from two high volume liver transplant centers across continents
Naresh Shanmugam1, Abdul Rahman Hakeem1, Joseph J Valamparampil1
1Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India.
Insights
Pediatric liver transplantation (LT) for hepatopulmonary syndrome (HPS) shows excellent survival. Very severe (VS) HPS requires longer ventilation and hospital stays, indicating a need for early LT.
Area of Science:
- Pediatric Hepatology
- Pulmonology
- Transplantation Medicine
Background:
- Severe hepatopulmonary syndrome (HPS) significantly increases morbidity and mortality in children undergoing liver transplantation (LT).
- This study reviews the combined experience of LT for HPS in pediatric patients from two international centers.
Purpose of the Study:
- To evaluate the outcomes of pediatric liver transplantation (LT) for hepatopulmonary syndrome (HPS).
- To assess the impact of HPS severity, categorized by pre-transplant oxygenation levels, on post-transplant outcomes.
Main Methods:
- Children with proven HPS underwent LT and were classified into four groups (M, Mo, S, VS) based on room air partial pressure of oxygen (PaO2).
- Outcomes including mechanical ventilation duration, intensive care unit (ICU) stay, hospital stay, and survival rates were analyzed.
Main Results:
- Twenty-four children underwent 25 LT procedures; 10 children experienced post-operative hypoxemia (S category) requiring inhaled nitric oxide (iNO).
- Patients with very severe (VS) HPS had significantly longer invasive ventilation, ICU, and hospital stays compared to S and M/Mo groups.
- Pre-transplant home oxygen therapy was the sole predictor for re-intubation; patient and graft survival rates were high (100% and 95.8%, respectively).
Conclusions:
- Very severe (VS) HPS is linked to prolonged mechanical ventilation and hospitalization after LT in children.
- These findings underscore the importance of considering early LT for children with VS HPS to improve outcomes.
- All children achieved complete resolution of HPS post-transplantation.
Background:
Severe HPS increases morbidity and mortality after LT in children. We reviewed the combined experience of LT for HPS in children from two LT centers in Europe and Asia.
Methods:
All children with "proven" HPS as per ERS Task Force criteria (detailed in manuscript) who underwent LT were categorized into M (PaO2 ≥80 mmHg), Mo (PaO2 = 60-79 mmHg), S (50-59 mmHg), and VS (PaO2 <50 mmHg) HPS, based on room air PaO2 .
Results:
Twenty-four children with HPS underwent 25 LT (one re-transplantation) at a median age of 8 years (IQR, 5-12), after a median duration of 8 (4-12) months following HPS diagnosis. Mechanical ventilation was required for a median of 3 (1.5-27) days after LT. Ten children had "S" post-operative hypoxemia, requiring iNO for a median of 5 (6-27) days. "VS" category patients had significantly prolonged invasive ventilation (median 35 vs. 3 and 1.5 days; p = .008), ICU stay (median 39 vs. 8 and 8 days; p = .007), and hospital stay (64 vs. 26.5 and 23 days; p < .001) when compared to "S" and "M/Mo" groups, respectively. The need for pre-transplant home oxygen therapy was the only factor predicting need for re-intubation. Patient and graft survival at 32 (17-98) months were 100% and 95.8%. All children ultimately had complete resolution of HPS.
Conclusions:
VS HPS is associated with longer duration of mechanical ventilation and hospital stay, which emphasizes the need for early LT in these children.
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