Hepatopulmonary syndrome in Japanese liver cirrhosis patients

Hepatopulmonary syndrome is characterized by hypoxemia induced by intrapulmonary vascular dilatations associated with hepatic diseases. We evaluated the frequency and case presentations revealed by general screening before liver transplantation. Sixty-one patients underwent arterial blood gas analysis in both upright and supine positions. Of these, 27 patients (44%) showed Pa0₂ <80 mmHg and AaD0₂ >15 mmHg, reflecting intrapulmonary shunting. Four patients exhibited Pa0₂ < 70 mmHg and orthodeoxia, defined as a fall in Pa0₂ >5% or 4 mmHg in an upright position. Finally, two patients showed hepatopulmonary syndrome, with positive findings on perfusion lung scanning. Both patients with hepatopulmonary syndrome had liver cirrhosis type C with habitual alcohol drinking and smoking. Potential pulmonary shunt patients with Pa0₂ < 80 mmHg and AaD0₂ >15 mmHg exhibited higher model for end-stage liver disease scores. Care should be taken regarding hepatopulmonary syndrome during liver cirrhosis management in Japanese patients.