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Liver transplantation and pulmonary gas exchanges in hypoxemic children
L Van Obbergh1, M Carlier, S C de Clety
1Department of Anesthesia, University of Louvain Medical School, Brussels, Belgium.
Insights
Children with hypoxemia due to intrapulmonary shunts can improve significantly after liver transplantation. This study shows successful regression of shunts and improved oxygen levels in pediatric patients receiving orthotopic liver grafts.
Area of Science:
- Pediatric Gastroenterology
- Pulmonary Medicine
- Transplantation Surgery
Background:
- Hypoxemia is common in cirrhotic patients, often linked to intrapulmonary shunts.
- Ventilation/perfusion (VA/Q) abnormalities in cirrhosis have been studied in adults using the multiple inert gas elimination technique (MIGET).
Purpose of the Study:
- To investigate intrapulmonary shunts and VA/Q abnormalities in children with hypoxemia as the primary indication for early liver transplantation.
- To assess the effect of orthotopic liver transplantation on these abnormalities.
Main Methods:
- Utilized the multiple inert gas elimination technique (MIGET) to evaluate intrapulmonary shunts and VA/Q distribution.
- Studied three pediatric patients with hypoxemia requiring early liver grafting.
Main Results:
- Hypoxemia was primarily caused by right-to-left shunts (VA/Q = 0) with minimal poorly ventilated areas (Low VA/Q).
- These significant VA/Q mismatches explained the poor response to increased inspired oxygen.
- Successful liver transplantation led to regression of intrapulmonary shunts.
Conclusions:
- Early liver transplantation can effectively resolve intrapulmonary shunts causing hypoxemia in children.
- MIGET demonstrated significant improvement in gas exchange post-transplantation.
- Successful transplantation enables a normal life for children with pre-transplant hypoxemia due to shunts.
Abstract:
Hypoxemia in cirrhotic patients is well documented. One of the possible causes of this association seems to be the presence of functional intrapulmonary shunts. The extent of the ventilation/perfusion ratio (VA/Q) abnormalities and their regression after orthotopic liver transplantation has been previously studied in adults by the multiple inert gas elimination technique. We report here a similar study in three children where the hypoxemia was the main indication for early liver grafting, although the liver function was still preserved at that time. Their hypoxemia was almost exclusively caused by a right to left shunt (VA/Q = 0) with a minimal amount of poorly ventilated but well perfused areas (Low VA/Q). This association may explain the poor response of the arterial oxygen pressure to an increased inspired oxygen concentration. Despite these very large VA/Q mismatches, the children underwent successful liver transplantations, resulting in a regression of the intrapulmonary shunt, as demonstrated by multiple inert gas elimination technique, and compatible with a normal life.