Outcome of liver transplantation for hepatopulmonary syndrome: a Eurotransplant experience

Hepatopulmonary syndrome (HPS) is a pulmonary vascular complication of liver disease that affects up to 30% of patients with cirrhosis [1]. Intrapulmonary vascular dilatations and shunts result in gas exchange abnormalities, ranging from elevated alveolar–arterial oxygen gradients with no hypoxaemia to very severe hypoxaemia [1, 2]. Currently, liver transplantation (LT) is the only treatment option [3]. The Model for End-Stage Liver Disease (MELD) is a scoring system for assessing liver disease severity that has been validated to predict the 3-month waiting list mortality and is used by Eurotransplant for prioritising allocation of liver transplants [4]. However, this score poorly predicts overall and post-transplant survival, and does not take into account complications that affect outcomes independent of liver disease severity [5]. Equal overall survival among liver transplantation candidates supports current prioritisation policy for severe hepatopulmonary syndrome The authors thank Roos Colman (Dept of Public Health, Biostatistics Unit, Ghent University, Ghent, Belgium) for her assistance in the statistical analysis of the data, the Eurotransplant representatives for supporting the organisation of this work and all Eurotransplant liver transplantation centres for providing data to the Eurotransplant registry.