Ghép gan cho bệnh nhân có hội chứng gan phổi: Kết quả và kinh nghiệm của Bệnh viện Nhi Trung ương

Abstract

Hepatopulmonary syndrome is a complication in patients with chronic liver disease or portal hypertension. The natural history of hepatopulmonary syndrome is poor, with 41% mortality within 2.5 years and a 5-years survival rate without liver transplantation of less than 23%. Liver transplantation is the only treatment that can completely reverse hepatopulmonary syndrome and improve long-term survival. The purpose of this study was to evaluate the results and recovery status after liver transplantation in 9 hepatopulmonary syndrome patients who received living donor liver transplantation at the Vietnam National Children's Hospital from September 2022 to October 2025; we also evaluated the improvement in oxygenation after transplantation, and studied related prognostic factors. All patients showed significant improvement in blood oxygenation, with recovery occurring in multiple stages. Specifically, SpO₂ levels normalized in most children within 1 month, whereas PaO2 and AaDO2 improved over 3 - 6 months. Post-transplant complications included graft rejection (33.3%), pleural effusion (22.2%), vascular stenosis (22.2%), prolonged mechanical ventilation (22.2%), persistent hypoxemia (11.1%), and pulmonary hypertension (11.1%). Pre-transplant AaDO₂, 99mTc-MAA shunt fraction, and hemoglobin were potential predictors of outcome. 100% of patients survived with marked improvement in respiratory function. 88.9% had complete oxygenation recovery, and 11.1% had partial recovery. Liver transplantation is a definitive treatment, reversing hepatopulmonary syndrome and improving survival in children. Initial results support the indication for liver transplantation for hepatopulmonary syndrome. Multicenter studies and longer-term follow-up are needed to further validate aforementioned findings.