Preoperative pulmonary assessment of children for liver transplantation

• Published in: Pediatric transplantation Vol. 12; no. 5; pp. 536 - 540
• Main Authors: Alves, Luciane, Sant'Anna, Clemax Couto, March, Maria de Fátima B. P., Ferreira, Sidnei, Marsillac, Marise, Tura, Mônica, Oñate, Hermes
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-08-2008; Blackwell
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Female; General aspects; Humans; Infant; Liver Diseases - metabolism; Liver Diseases - therapy; Liver Transplantation - methods; Liver, biliary tract, pancreas, portal circulation, spleen; Lung - pathology; Lung - physiology; lung transplantation; Male; Medical sciences; preoperative assessment; Prostheses and Implants; Pulmonary Diffusing Capacity; Pulmonary Gas Exchange; Retrospective Studies; Spirometry; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Human; Pediatrics; Digestive system; Liver; Lung; Homotransplantation; Respiratory system; Treatment; Surgery; Graft; lung transplantation; Preoperative; Child; preoperative assessment; Liver transplantation
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/j.1399-3046.2007.00845.x

:  Pulmonary assessment should be part of the preoperative investigation of pediatric patients with chronic liver disease undergoing liver transplantation, as it allows the identification of pulmonary alterations that influence candidacy for transplantation and survival. To describe pulmonary changes found in pediatric patients who were candidates for liver transplantation. Retrospective study of 17 pediatric liver transplant candidates undergoing preoperative pulmonary evaluation assessing pulmonary clinical data, arterial blood gas analysis, CXR, respiratory function test by spirometry, pulmonary scintigraphy, and CEE. Ten patients presented normal chest roentgenograms. The most common radiographic change was interstitial infiltrate in the lung bases. Of the five patients with PaO2 <70 mmHg, four had cyanosis and dyspnea and two were diagnosed with HPS with intrapulmonary shunt evidenced by contrast echocardiogram. Two patients presented with intrapulmonary shunt but without hypoxemia. Spirometry was normal in six patients, restrictive disturbance was evidenced in one patient, obstructive in three, and combined in two. The most common scintigraphic change was heterogeneous pulmonary perfusion. Pulmonary assessment should be performed routinely in pediatric patients prior to liver transplantation, even in asymptomatic patients. Pulmonary assessment may indicate changes such as HPS that can increase postoperative morbidity/mortality.