CHILDHOOD CIRRHOSIS, HEPATOPULMONARY SYNDROME AND LIVER TRANSPLANTATION
Makaleler > Tam Makale · 2005
Yazarlar: G Tumgor, C Arikan, HA Yuksekkaya, Reşit Ertürk LEVENT, C Dorak, Ruhsar Damla GÖKŞEN, M Kilic, Sema AYDOĞDU
Journal of Pediatric Gastroenterology and Nutrition, Uluslararası, Wos, 2005, cilt 40, ss 673-673
DOI: 10.1002/j.1536-4801.2005.tb01118.x
Özet
The hepatopulmonary syndrome (HPS) is characterized as a triad: liver disease, intrapulmonary vascular dilatatiton, and arterial hypoxemia. Hepatopulmonary syndrome have developed as a consequence of hepatic dysfunction. To investigate pulmonary complications in children with cirrhosis 52 children (26 boys, 29 girls) with cirrhosis were included to study. Age of children ranged from 6 months to 22 years with median age of 10 years. Cirrhosis and its complications were determined by biochemical, serologic, histopathologic, sonographic and endoscopic investigations. Among 52 cases; 27 had noncholestatic and 25 had cholestatic hapatic failure signs. According to Child Pugh scores; 15 of patients were Child A, 15 of them were Child B and 18 of them were Child C (4 cases fulminant hepatic failure). All patients were evaluated by chest radiography, arterial blood gas analysis, contrast echocardiography (ECHO). To determinate pulmonary arteriovenous (AV) shunts, %20 galactose solution and saline were used as a contrast material during ECHO. In this study HPS established in 17 patients (%32) by contrast ECHO. Among HPS; 5 were Child A (%33), 3 were Child B (%17) and 9 were Child C(%50). 9 patients (%16.3) were hypoxemic (PaO2 < 70 mmHg). 4 of them had severe hypoxemia.(PaO2 < %50). 9 of patients with HPS had liver transplantation in which the ECHO findings regressed in all of them postop on 6th month. Arterial blood gas analysis of these patients were improved postop on 6th. None of them had pulmonary hypertension. HPS was determined in %37 (10/27) non cholestatic patients and in 7 of 25 (%28) cholestatic patients. There was no statistically difference between cholestatic and noncholestatic patients with respect to the risk of HPS developed. HPS is a serious and important complication of cirrhotic children that leads to tissue hypoxi and santral ciyanosis. To determine HPS before transplantation is very important to follow up postoperative intensive care and to evaluate hypoxia and hypocapnia. HPS seems reversible after liver transplantaion in many patients.