Año 2017 / Volumen 109 / Número 5
Original
The utility of the macro-aggregated albumin lung perfusion scan in the diagnosis and prognosis of hepatopulmonary syndrome in cirrhotic patients candidates for liver transplantation

335-343

DOI: 10.17235/reed.2017.4219/2016

Israel Grilo, Juan Manuel Pascasio, Juan Luis Tirado, Francisco-Jesús López-Pardo, Francisco Ortega-Ruiz, José Manuel Sousa, María José Rodríguez-Puras, María Teresa Ferrer, Miguel Ángel Gómez-Bravo, Antonio Grilo Reina,

Resumen
Background: The macro-aggregated albumin lung perfusion scan (99mTc-MAA) is a diagnostic method for hepatopulmonary syndrome (HPS). Goal: To determine the sensitivity of 99mTc-MAA in diagnosing HPS, to establish the utility of 99mTc-MAA in determining the influence of HPS on hypoxemia in patients with concomitant pulmonary disease and to determine the correlation between 99mTc-MAA values and other respiratory parameters. Methods: Data from 115 cirrhotic patients who were eligible for liver transplantation (LT) were prospectively analyzed. A transthoracic contrast echocardiography and 99mTc-MAA were performed in 85 patients, and 74 patients were diagnosed with HPS. Results: The overall sensitivity of 99mTc-MAA for the diagnosis of HPS was 18.9% (14/74) in all of the HPS cases and 66.7% (4/6) in the severe to very severe cases. In HPS patients who did not have lung disease, the degree of brain uptake of 99mTc-MAA was correlated with the alveolar-arterial oxygen gradient (A-a PO2) (r = 0.32, p < 0.05) and estimated oxygen shunt (r = 0.41, p < 0.05) and inversely correlated with partial pressure of arterial oxygen (PaO2) while breathing 100% O2 (r = -0.43, p < 0.05). The 99mTc-MAA was positive in 20.6% (7/36) of the patients with HPS and lung disease. The brain uptake of 99mTc-MAA was not associated with mortality and normalized in all cases six months after LT. Conclusions: The 99mTc-MAA is a low sensitivity test for the diagnosis of HPS that can be useful in patients who have concomitant lung disease and in severe to very severe cases of HPS. It was not related to mortality, and brain uptake normalized after LT.
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Bibliografía
1.- Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MB; ERS Task Force Pulmonary-Hepatic Vascular Disorders (PHD) Scientific Committee. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J 2004; 24: 861-880.
2.- Rodríguez Roisin R, Krowka MJ. Hepatopulmonary syndrome. A liver-induced lung vascular disorder. N Engl J Med 2008; 358: 2378-87.
3.- Aller R, Moya JL, Moreira V, Boixeda D, et al. Diagnosis of hepatopulmonary syndrome with contrast transesophageal echocariography. Advantages over contrast transthoracic echocardiography. Dig Dis Sci 1999; 44: 1243-1248.
4.-Abrams GA, Jaffe CC, Hoffer PB, Binder HJ, Fallon MB. Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome. Gastroenterology 1995; 109.1283-1288.
5.- Abrams GA, Nanda NC, Dubovsky EV, Krowka MJ, Fallon MB. Use of macroaggregated albuming lung perfusion scan to diagnose hepatopulmonary syndrome: a new approach.Gastroenterology 1998; 114: 305-310.
6.- Krowka MJ, Wiseman GA, Burnett OL et al. Hepatopulmonary syndrome: a prospective study of relationships between severity of liver disease, PaO(2) response to 100% oxygen, and brain uptake after (99m)Tc MAA lung scanning. Chest 2000;118:615-624.
7.-Arguedas MR, Abrams GA, Krowka MJ, Fallon MB.Prospective evaluation of outcomes and predictors of mortality in patients with hepatopulmonary syndrome undergoing liver transplantation.Hepatology 2003; 37: 192-197.
8.-Swanson KL, Wiesner RH, Krowka MJ. Natural history of hepatopulmonary syndrome: Impact of liver transplantation. Hepatology 2005; 41: 1122-1129.
9.- Márquez E, Jara L, Ortega F, et al. Síndrome hepatopulmonar en paciente con hepatopatía avanzada: estudio de 24 casos. Med Clin (Barc) 2008; 130: 98-102.
10.- Rodriguez-Roisin R, Roca J. Hepatopulmonary syndrome: the paradigm of liver-induced hypoxaemia. Baillieres Clin Gastroenterol 1997; 11: 387-406.
11.- Krowka MJ. Hepatopulmonary syndrome: recent literature (1997 to 1999) and implications for liver transplantation.Liver Transpl 2000; 6: S31-S35.
12.- Kim HY, Choi MS, Lee SC, et al. Outcomes in patients with hepatopulmonary syndrome undergoing liver transplantation.Transpl Proc 2004; 36: 2762-2763.
13.- Deberaldini M, Arcanjo ABB, Melo E, et al. Hepatopulmonary syndrome: morbidity and survival after liver transplantation. Transpl Proc 2008; 40: 3512-3516.
14.- Gupta S, Castel H, Rao RV et al. Improved survival after liver transplantation in patients with hepatopulmonary syndrome.Am J Transplant 2009; 9: 1-10.
15.- Martínez-Palli G, Gómez FP, Barberá JA, et al. Sustained low diffusing capacity in hepatopulmonary syndrome after liver transplantation. World J Gastroenterol 2006; 12: 5878-5883.
16.- Pascasio JM, Grilo I, López-Pardo FJ, et al. Prevalence and severity of hepatopulmonary syndrome and its influence on survival in cirrhotic patients evaluated for liver trasplantation. Am J Transplant 2014; 14: 1391-1399.
17.- Chiang St. A nomogran for venous shunt calculation. Thorax. 1968:23: 536-5
18. Krowka MJ, Mandell MS, Ramsay MA et al. Hepatopulmonary syndrome and portopulmonary hypertension: a report of the multicenter liver transplant database. Liver Transpl 2004;10:174-182.
19.- Taille C, Cadranel J, Bellocq A, et al. Liver transplantation for hepatopulmonary syndrome: a ten-year experience in Paris, France. Transplantation 2003; 75: 1482-1489.
20.- Whyte MK, Hughes JM, Peters AM, Ussov W, Patel S, Burroughs AK. Analysis of intrapulmonary right to left shunt in the hepatopulmonary syndrome. J Hepatol. 1998; 29:85-93.
21.- Aller R, Moya JL, Moreira V, et al. Diagnosis and grading of intrapulmonary vascular dilatation in cirrhotic patients with contrast transesophageal echocardiography. J Hepatol 1999; 31: 1044-1052.
22.- Schenk P, Fuhrmann V, Madl C, et al. Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut 2002; 51: 853-859.
23.- Lima BL, França AV, Pazin-Filho A, et al. Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome.Mayo Clin Proc 2004; 79: 42-48.
24.- Iyer VN, Swanson KL, Cartin-Ceba R, Dierkhising RA, Rosen CB, Heimbach JK,Wiesner RH, Krowka MJ. Hepatopulmonary syndrome: favorable outcomes in the MELDexception era. Hepatology. 2013; 57:2427-2435
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Instrucciones para citar
Grilo I, Pascasio J, Tirado J, López-Pardo F, Ortega-Ruiz F, Sousa J, et all. The utility of the macro-aggregated albumin lung perfusion scan in the diagnosis and prognosis of hepatopulmonary syndrome in cirrhotic patients candidates for liver transplantation . 4219/2016


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Ficha Técnica

Recibido: 23/01/2016

Aceptado: 08/01/2017

Prepublicado: 17/03/2017

Publicado: 03/05/2017

Tiempo de revisión del artículo: 347 días

Tiempo de prepublicación: 419 días

Tiempo de edición del artículo: 466 días


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