The impact of intrapulmonary shunting after liver transplantation in pediatric patients

Intrapulmonary shunting (IPS) due to pulmonary vascular dilatation is frequently observed among patients with end-stage liver disease (ESLD). This study investigated the prevalence and impact of IPS after liver transplantation (LT) in children. Methods: A total of 77 pediatric patients who underwent primary LT were enrolled. All patients had trans-thoracic contrast echocardiography before LT and at least 1 year after transplantation. The patients with IPS and without IPS after LT were designated as group 1 and group 2, respectively. Results: The prevalence of IPS after LT was 6.1%. The patients in group 1 (n=5) were younger (6.4 +/- 2.8 vs. 9.9 +/- 3.6, p=0.036) than in group 2 (n=72). There were no significant differences in gender, weight, hemoglobin level, O2 saturation, or complications between the two groups. Fourteen patients had abnormal liver function tests, two patients in group 1 and 12 patients in group 2 (p=0.22).The overall follow-up period was 6.7 +/- 2.7 years (range, 1.6–13.0). At the latest follow-up, all 5 patients with mild IPS after LT remain asymptomatic with good liver graft function. Conclusion: Among pediatric ESLD patients with preoperative IPS, approximately 6% continue to have mild IPS after LT. Patients with mild IPS after LT remain asymptomatic and have good liver graft function.