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The Canadian Hepatopulmonary Syndrome Program: A Longitudinal Liver Transplant Experience
Samir Gupta1,2, Xun Zhao3,4, Tom Chang5
1Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada.
Journal of Clinical and Experimental Hepatology
|October 31, 2025
Summary
Liver transplantation (LT) offers curative treatment for hepatopulmonary syndrome (HPS). Higher baseline oxygen levels and absence of obstructive lung disease predict better post-LT survival in severe HPS patients.
Area of Science:
- Hepatology
- Pulmonology
- Transplantation Medicine
Background:
- Hepatopulmonary syndrome (HPS) is a severe complication of liver disease characterized by abnormal oxygenation.
- Liver transplantation (LT) is the only cure for HPS, but data on outcomes in severe cases are limited.
Purpose of the Study:
- To report short- and long-term outcomes of LT in a cohort of patients with hepatopulmonary syndrome.
- To identify predictors of mortality and complications following LT for HPS.
Main Methods:
- Retrospective cohort study of 53 patients with HPS undergoing LT.
- Analysis of mortality, complications, and oxygenation normalization post-LT.
- Multivariable analysis to identify predictors of post-LT death.
Main Results:
- 1, 5, and 10-year post-LT mortality rates were 7.5%, 17%, and 48%, respectively.
- Higher baseline partial pressure of arterial oxygen (PaO2) and absence of obstructive lung disease were associated with lower mortality risk.
- Oxygenation normalized in 97.9% of patients; infectious and biliary complications were common.
Conclusions:
- High-volume centers with HPS expertise may offer better outcomes for severe HPS patients undergoing LT.
- Close monitoring for complications and comorbid obstructive lung disease is crucial post-LT.
- This study provides valuable data for patient counseling and managing expectations after LT for HPS.
