Síndrome hepatopulmonar: sobrevida e morbidade precoce e sobrevida a longo prazo após o transplante de fígado

• Ano de defesa: 2006
• Autor(a) principal: Deberaldini, Maristela
• Orientador(a): Silva, Rita de Cássia Martins Alves da
• Banca de defesa: Boin, Ilka de Fátima Santana Ferreira , Orrico, Susana Renata Perez
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Faculdade de Medicina de São José do Rio Preto
• Programa de Pós-Graduação: Programa de Pós-Graduação em Ciências da Saúde
• Departamento: Medicina Interna; Medicina e Ciências Correlatas
• País: BR
• Palavras-chave em Português: Síndrome Hepatopulmonar; Transplante de Fígado; Vasodilatação; Cirrose Hepatica; Distúrbio Ventilação-Perfusão.; Relação Ventilação-perfusão; Morbidade
• Palavras-chave em Inglês: Hepatopulmonary Syndrome; Liver Transplantation; Vasodilation; Liver Cirrhosis; Ventilation-Perfusion Ratio; Morbilidity
• Palavras-chave em Espanhol: Transplante de Hígado; Vasodilatacíon; Cirrosis Hepática; Relación ventilação-perfusão; Morbilidad
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL
• Link de acesso: http://bdtd.famerp.br/handle/tede/233

Hepatopulmonary syndrome (HPS) is a clinical triad characterized by the presence of intrapulmonary vascular dilation (IPVD) and arterial hypoxemia with hepatic disease. Liver transplantation constitutes the only cure for HPS; possibly providing a complete reversal of the symptoms. However, an association between HPS and adverse results has been reported with liver transplantation. Data on long-term survival of transplant patients with HPS are scarce. The objective of this study was to evaluate the short-term postoperative complications and short- and long-term survival in the postoperative period of transplant patients with and without HPS. Fifty-nine cirrhotic patients transplanted in the period from October 2001 to May 2004 were evaluated in this study. The patients were divided into two groups: with HPS (HPS Group n = 25) and without HPS (Control group n = 34). IPVD was diagnosed by echocardiogram contrasted using microbubbles. Hypoxemia was defined as D(A-a)O2 &#8805; 15 mmHg. The following variables were considered after liver transplantation: immediate survival (within the hospitalization period after transplantation), late survival (at 48 months), causes of death, time of hospital stay, time of ICU, time of ventilatory support, the necessity of re-intubation and complications. The results were analysed utilizing the following statistical tests: T-test to compare means, the non-parametric Mann-Whitney test to compare medians and ANOVA and chi-squared tests for qualitative variables. A level of significance of 0.05 for &#945; was adopted. The HPS and Control Groups were homogeneous in respect to age (p-value = 0.36; 43.8 ± 12.2 vs. 46.9 ± 13.5) and gender (p-value = 0.47), with a predominance of men in both groups (68 and 78%, respectively). They were also similar in respect to the severity of hepatic disease and the presence of ascitis. The PaO2 was significantly lower (74.9 ± 12.1 vs. 93 ± 6.4 mmHg; P-value < 0.001) and the D(A-a)O2 was significantly higher in the HPS Group compared to the Control Group. There were 10 patients with mild hypoxemia (40%), 11 with moderate hypoxemia (44%) and 4 with severe/very severe hypoxemia (16%) in the HPS Group. There were no significant differences between the groups with and without HPS in relation to early (68% vs. 77%; p-value = 0.27) and late (60% vs. 64%; p-value = 0.67) survival; time in ICU (median 7.0 vs. 5.5; p-value = 0.41); time on ventilatory support (median 38.0 vs. 27.5; p-value = 0.43); re-intubation rate (32.0% vs. 23.5%; p-value = 0.45) and complications (p-value = 0.72) in the immediate post-transplantation period. In conclusion, there were no significant differences in the results of liver transplantation of patients with and without HPS in respect to immediate morbidity or in relation to early and late survival 48 months after the procedure. The predominance of patients with mild and moderate HPS in the group may have influenced our results.