Orthotopic liver transplantation in children with chronic liver disease and severe hypoxemia

Liver transplantation has been considered until recently as an absolute contraindication in hypoxemic patients. We report our experience in nine patients who had orthotopic liver transplantation between June 1986 and June 1992. These patients had cirrhosis-related hypoxemia with intrapulmonary shunting (IPS). The arterial oxygen pressure (PaO₂ on room air ranged from 47 to 78 mmHg. OLT resulted in resolution of hypoxemia and closure of IPS in five patients whose hypoxemia was higher than 60 mmHg, and in death for the remaining four patients who had severe hypoxemia (PaO₂ <60 mmHg). We conclude that hypoxemia is no longer a contraindication to liver transplantation. Patients having PaO₂ levels higher than 60 mmHg should have OLT as soon as possible before reaching lower levels of PaO₂, and combined lungliver transplantation or heart-lung-liver transplantation should be discussed in patients with severe hypoxemia (PaO₂ <60 mmHg).