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Current Gastroenterology Reports

, Volume 13, Issue 1, pp 34–39 | Cite as

Pulmonary Complications of Cirrhosis

  • Rajan Kochar
  • Moises I. Nevah Rubin
  • Michael B. FallonEmail author
Article

Abstract

Pulmonary vascular complications of liver disease comprise two distinct clinical entities: hepatopulmonary syndrome (HPS—microvascular dilatation and angiogenesis) and portopulmonary hypertension (POPH—vasoconstriction and remodeling in resistance vessels). These complications occur in similar pathophysiologic environments and may share pathogenic mechanisms. HPS is found in 15% to 30% of patients with cirrhosis and its presence increases mortality and the risks of liver transplantation, particularly when hypoxemia is present. Contrast echocardiography and arterial blood gas analysis are required to establish the diagnosis. No medical therapies are available, although liver transplantation is effective in reversing the syndrome. POPH is found in 4% to 8% of patients undergoing liver transplantation evaluation, and the presence of moderate to severe disease significantly increases perioperative transplant mortality. Transthoracic echocardiography is recommended for screening and right-heart catheterization is required to establish the diagnosis. Medical therapies are increasingly effective in improving pulmonary vascular hemodynamics in POPH and may result in better perioperative outcomes.

Keywords

Hepatopulmonary syndrome Portopulmonary hypertension Liver transplantation Pulmonary hypertension Intrapulmonary vasodilation Intrapulmonary shunting Pulmonary vascular complications of liver disease Contrast echocardiography 

Notes

Disclosure

No potential conflict of interest relevant to this article was reported.

References

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Rajan Kochar
    • 1
  • Moises I. Nevah Rubin
    • 1
  • Michael B. Fallon
    • 1
    Email author
  1. 1.Division of Gastroenterology, Hepatology, and NutritionThe University of Texas Health Science Center at HoustonHoustonUSA

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