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Pulmonale Affektion bei fortgeschrittener Lebererkrankung – hepatopulmonales Syndrom und portopulmonale Hypertonie

Pulmonary Affection in Advanced Liver Disease – Hepatepulonary Syndrome and Portopulmonary Hypertension

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Zusammenfassung

Bei Patienten mit fortgeschrittener Lebererkrankung, insbesondere einer Zirrhose, muss mit pulmonalen Komplikationen gerechnet werden. Hierbei steht klinisch meist die Dyspnoe im Vordergrund. Die Dyspnoe kann einerseits indirekt im Rahmen der Grunderkrankung verursacht sein, wie durch Aszites, Muskelschwäche oder Anämie. Sie kann andererseits auch multifaktoriell bedingt sein, wenn neben der Lebererkrankung eine koronare Herzerkrankung (KHK) oder eine chronisch obstruktive Lungenerkrankung (COPD) vorliegt. Als die relevantesten pulmonalen Komplikationen gelten bei Patienten mit Leberzirrhose das hepatopulmonale Syndrom (HPS) und die portopulmonale Hypertonie (PoPH). Das HPS scheint häufiger aufzutreten als die PoPH, wobei beide Erkrankungen die Morbidität und auch Mortalität bei Patienten mit einer Lebererkrankung erhöhen. Die beiden Erkrankungen müssen voneinander differenziert werden, da sie histopathologisch und pathophysiologisch auf gegensätzlichen Prinzipien beruhen. Während das hepatopulmonale Syndrom eine dilatative pulmonalvaskuläre Erkrankung ist, stellt die portopulmonale Hypertonie eine konstriktive bzw. obliterative pulmonalvaskuläre Erkrankung im Rahmen einer Lebererkrankung und/oder einer portalen Hypertonie dar. Entsprechend unterscheiden sich diese beiden Krankheitsbilder auch hinsichtlich ihrer Diagnostik und Therapie teilweise grundlegend.

Abstract

Patients suffering from severe chronic liver disease, in particular cirrhosis, are at risk for pulmonary complications. The leading clinical symptom is shortness of breath, which can accompany the actual disease as indirect effect because of anemia, faint muscles or ascites. On the other hand, dyspnea can have multiple additive causes in case of accompanying cardial or pulmonary disease. The hepatopulmonary syndrome (HPS) and the portopulmonary hypertension (PoPH) belong to the most relevant pulmonary complications in liver cirrhosis. HPS appears to be more common than PoPH and the presence of either entity increases morbidity and mortality in patients with liver disease. The two diseases have to be strictly distinguished, as they have opposed histological and pathophysiological origin. While the HPS is a dilatative pulmonary- vascular disease, the PoPH is a constrictive or obliterative pulmonaryvascular disease in the context of a liver disease or a portal hypertension. Therefore, these diseases are separate entities also when it comes to diagnostics and therapy.

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Literatur

  1. Kaymakoglu S, Kahraman T, Kudat H, Demir K, Cakaloglu Y, Adalet I, Dincer D, Besisik F, Boztas G, Sozen AB, Mungan Z, and Okten A. Hepatopulmonary syndrome in noncirrhotic portal hypertensive patients. Dig Dis Sci, 48: 556–560, 2003.

    Article  PubMed  CAS  Google Scholar 

  2. Teuber G, Teupe C, Dietrich CF, Caspary WF, Buhl R, and Zeuzem S. Pulmonary dysfunction in non-cirrhotic patients with chronic viral hepatitis. Eur J Intern Med, 13: 311–318, 2002.

    Article  PubMed  Google Scholar 

  3. Abrams GA and Fallon MB. The hepatopulmonary syndrome. Clin Liver Dis, 1: 185–200, xiii, 1997.

    Article  PubMed  CAS  Google Scholar 

  4. De BK, Sen S, Biswas PK, Sanyal R, Majumdar D, and Biswas J. Hepatopulmonary syndrome in inferior vena cava obstruction responding to cavoplasty. Gastroenterology, 118: 192–196, 2000.

    Article  PubMed  CAS  Google Scholar 

  5. Martinez-Palli G, Vidal JB, Beltran J, and Taura P. Portopulmonary hypertension and hepatopulmonary syndrome: two different entities affecting pulmonary vasculature in liver disease. Crit Care Med, 33: 269, 2005.

    Article  PubMed  Google Scholar 

  6. Scott VL, Dodson SF, and Kang Y. The hepatopulmonary syndrome. Surg Clin North Am, 79: 23–41, vii, 1999.

    Article  PubMed  CAS  Google Scholar 

  7. Gschossmann JM, Essig M, Reichen J, Scheurer U, and Gerken G. [The hepato-pulmonary syndrome-where do we stand in the year 2006?]. Z Gastroenterol, 44: 249–256, 2006.

    Article  PubMed  CAS  Google Scholar 

  8. Rodriguez-Roisin R and Krowka MJ. Hepatopulmonary syndrome-a liver-induced lung vascular disorder. N Engl J Med, 358: 2378–2387, 2008.

    Article  PubMed  CAS  Google Scholar 

  9. Hoeper MM, Krowka MJ, and Strassburg CP. Portopulmonary hypertension and hepatopulmonary syndrome. Lancet, 363: 1461–1468, 2004.

    Article  PubMed  Google Scholar 

  10. Schenk P, Schoniger-Hekele M, Fuhrmann V, Madl C, Silberhumer G, and Muller C. Prognostic significance of the hepatopulmonary syndrome in patients with cirrhosis. Gastroenterology, 125: 1042–1052, 2003.

    Article  PubMed  Google Scholar 

  11. Krowka MJ, Dickson ER, and Cortese DA. Hepatopulmonary syndrome. Clinical observations and lack of therapeutic response to somatostatin analogue. Chest, 104: 515–521, 1993.

    Article  PubMed  CAS  Google Scholar 

  12. Zhang J, Luo B, Tang L, Wang Y, Stockard CR, Kadish I, Van Groen T, Grizzle WE, Ponnazhagan S, and Fallon M. B. Pulmonary angiogenesis in a rat model of hepatopulmonary syndrome. Gastroenterology, 136: 1070–1080, 2009.

    Article  PubMed  CAS  Google Scholar 

  13. Cremona G, Higenbottam TW, Mayoral V, Alexander G, Demoncheaux E, Borland C, Roe P, and Jones GJ. Elevated exhaled nitric oxide in patients with hepatopulmonary syndrome. Eur Respir J, 8: 1883–1885, 1995.

    Article  PubMed  CAS  Google Scholar 

  14. Rolla G, Brussino L, Colagrande P, Scappaticci E, Morello M, Bergerone S, Ottobrelli A, Cerutti E, Polizzi S, and Bucca C. Exhaled nitric oxide and impaired oxygenation in cirrhotic patients before and after liver transplantation. Ann Intern Med, 129: 375–378, 1998.

    PubMed  CAS  Google Scholar 

  15. Rolla G, Brussino L, Colagrande P, Dutto L, Polizzi S, Scappaticci E, Bergerone S, Morello M, Marzano A, Martinasso G, Salizzoni M, and Bucca C. Exhaled nitric oxide and oxygenation abnormalities in hepatic cirrhosis. Hepatology, 26: 842–847, 1997.

    Article  PubMed  CAS  Google Scholar 

  16. Brussino L, Bucca C, Morello M, Scappaticci E, Mauro M, and Rolla G. Effect on dyspnoea and hypoxaemia of inhaled N(G)-nitro-L-arginine methyl ester in hepatopulmonary syndrome. Lancet, 362: 43–44, 2003.

    Article  PubMed  CAS  Google Scholar 

  17. Rabiller A, Nunes H, Lebrec D, Tazi KA, Wartski M, Dulmet E, Libert JM, Mougeot C, Moreau R, Mazmanian M, Humbert M, and Herve P. Prevention of gram-negative translocation reduces the severity of hepatopulmonary syndrome. Am J Respir Crit Care Med, 166: 514–517, 2002.

    Article  PubMed  Google Scholar 

  18. Sztrymf B, Rabiller A, Nunes H, Savale L, Lebrec D, Le Pape A, de Montpreville V, Mazmanian M, Humbert M, and Herve P. Prevention of hepatopulmonary syndrome and hyperdynamic state by pentoxifylline in cirrhotic rats. Eur Respir J, 23: 752–758, 2004.

    Article  PubMed  CAS  Google Scholar 

  19. Zhang J, Ling Y, Tang L, Luo B, Chacko BK, Patel RP, and Fallon MB. Pentoxifylline attenuation of experimental hepatopulmonary syndrome. J Appl Physiol, 102: 949–955, 2007.

    Article  PubMed  CAS  Google Scholar 

  20. Khoruts A, Stahnke L, McClain CJ, Logan G, and Allen JI. Circulating tumor necrosis factor, interleukin-1 and interleukin-6 concentrations in chronic alcoholic patients. Hepatology, 13: 267–276, 1991.

    Article  PubMed  CAS  Google Scholar 

  21. Fernandez M, Vizzutti F, Garcia-Pagan JC, Rodes J, and Bosch J. Anti-VEGF receptor-2 monoclonal antibody prevents portal-systemic collateral vessel formation in portal hypertensive mice. Gastroenterology, 126: 886–894, 2004.

    Article  PubMed  CAS  Google Scholar 

  22. Fallon MB and Abrams GA. Pulmonary dysfunction in chronic liver disease. Hepatology, 32: 859–865, 2000.

    Article  PubMed  CAS  Google Scholar 

  23. Cardenas A, Kelleher T, and Chopra S. Review article: hepatic hydrothorax. Aliment Pharmacol Ther, 20: 271–279, 2004.

    Article  PubMed  CAS  Google Scholar 

  24. Gomez FP, Martinez-Palli G, Barbera JA, Roca J, Navasa M, and Rodriguez-Roisin R. Gas exchange mechanism of orthodeoxia in hepatopulmonary syndrome. Hepatology, 40: 660–666, 2004.

    Article  PubMed  Google Scholar 

  25. Krowka MJ and Cortese DA. Pulmonary aspects of chronic liver disease and liver transplantation. Mayo Clin Proc, 60: 407–418, 1985.

    PubMed  CAS  Google Scholar 

  26. Naeije R. Hepatopulmonary syndrome and portopulmonary hypertension. Swiss Med Wkly, 133: 163–169, 2003.

    PubMed  Google Scholar 

  27. Rodriguez-Roisin R, Krowka MJ, Herve P, and Fallon MB. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J, 24: 861–880, 2004.

    Article  PubMed  CAS  Google Scholar 

  28. Aller R, Moya JL, Moreira V, Boixeda D, Cano A, Picher J, Garcia-Rull S, and de Luis DA. Diagnosis of hepatopulmonary syndrome with contrast transesophageal echocardiography: advantages over contrast transthoracic echocardiography. Dig Dis Sci, 44: 1243–1248, 1999.

    Article  PubMed  CAS  Google Scholar 

  29. Krowka MJ. Hepatopulmonary syndromes. Gut, 46: 1–4, 2000.

    Article  PubMed  CAS  Google Scholar 

  30. Hoeper MM, Halank M, Marx C, Hoeffken G, Seyfarth HJ, Schauer J, Niedermeyer J, and Winkler J. Bosentan therapy for portopulmonary hypertension. Eur Respir J, 25: 502–508, 2005.

    Article  PubMed  CAS  Google Scholar 

  31. Reichenberger F, Voswinckel R, Steveling E, Enke B, Kreckel A, Olschewski H, Grimminger F, Seeger W, and Ghofrani HA. Sildenafil treatment for portopulmonary hypertension. Eur Respir J, 28: 563–567, 2006.

    Article  PubMed  CAS  Google Scholar 

  32. Kuo PC, Johnson LB, Plotkin JS, Howell CD, Bartlett ST, and Rubin LJ. Continuous intravenous infusion of epoprostenol for the treatment of portopulmonary hypertension. Transplantation, 63: 604–606, 1997.

    Article  PubMed  CAS  Google Scholar 

  33. Allgaier HP, Haag K, Ochs A, Hauenstein KH, Jeserich M, Krause T, Heilmann C, Gerok W, and Rossle M. Hepato-pulmonary syndrome: successful treatment by transjugular intrahepatic portosystemic stent-shunt (TIPS). J Hepatol, 23: 102, 1995.

    Article  PubMed  CAS  Google Scholar 

  34. Corley DA, Scharschmidt B, Bass N, Somberg K, and Gold W. Lack of efficacy of TIPS for hepatopulmonary syndrome. Gastroenterology, 113: 728–730, 1997.

    Article  PubMed  CAS  Google Scholar 

  35. Riegler JL, Lang KA, Johnson SP, and Westerman JH. Transjugular intrahepatic portosystemic shunt improves oxygenation in hepatopulmonary syndrome. Gastroenterology, 109: 978–983, 1995.

    Article  PubMed  CAS  Google Scholar 

  36. Selim KM, Akriviadis EA, Zuckerman E, Chen D, and Reynolds TB. Transjugular intrahepatic portosystemic shunt: a successful treatment for hepatopulmonary syndrome. Am J Gastroenterol, 93: 455–458, 1998.

    Article  PubMed  CAS  Google Scholar 

  37. Paramesh AS, Husain SZ, Shneider B, Guller J, Tokat I, Gondolesi GE, Moyer S, and Emre S. Improvement of hepatopulmonary syndrome after transjugular intrahepatic portasystemic shunting: case report and review of literature. Pediatr Transplant, 7: 157–162, 2003.

    Article  PubMed  Google Scholar 

  38. Lasch HM, Fried MW, Zacks SL, Odell P, Johnson MW, Gerber DA, Sandhu FS, Fair JH, and Shrestha R. Use of transjugular intrahepatic portosystemic shunt as a bridge to liver transplantation in a patient with severe hepatopulmonary syndrome. Liver Transpl, 7: 147–149, 2001.

    Article  PubMed  CAS  Google Scholar 

  39. Felt RW, Kozak BE, Rosch J, Duell BP, and Barker AF. Hepatogenic pulmonary angiodysplasia treated with coil-spring embolization. Chest, 91: 920–922, 1987.

    Article  PubMed  CAS  Google Scholar 

  40. Ryu JK and Oh JH. Hepatopulmonary syndrome: angiography and therapeutic embolization. Clin Imaging, 27: 97–100, 2003.

    Article  PubMed  Google Scholar 

  41. Swanson KL, Wiesner RH, and Krowka MJ. Natural history of hepatopulmonary syndrome: Impact of liver transplantation. Hepatology, 41: 1122–1129, 2005.

    Article  PubMed  Google Scholar 

  42. Halank M, Ewert R, Seyfarth HJ, and Hoeffken G. Portopulmonary hypertension. J Gastroenterol, 41: 837–847, 2006.

    Article  PubMed  Google Scholar 

  43. McDonnell PJ, Toye PA, and Hutchins, GM. Primary pulmonary hypertension and cirrhosis: are they related? Am Rev Respir Dis, 127: 437–441, 1983.

    PubMed  CAS  Google Scholar 

  44. Hadengue A, Benhayoun MK, Lebrec D, and Benhamou JP. Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology, 100: 520–528, 1991.

    PubMed  CAS  Google Scholar 

  45. Krowka MJ, Swanson KL, Frantz RP, McGoon MD, and Wiesner RH. Portopulmonary hypertension: Results from a 10-year screening algorithm. Hepatology, 44: 1502–1510, 2006.

    Article  PubMed  Google Scholar 

  46. Robalino BD and Moodie DS. Association between primary pulmonary hypertension and portal hypertension: analysis of its pathophysiology and clinical, laboratory and hemodynamic manifestations. J Am Coll Cardiol, 17: 492–498, 1991.

    Article  PubMed  CAS  Google Scholar 

  47. Swanson KL, Wiesner RH, Nyberg SL, Rosen CB, and Krowka MJ. Survival in portopulmonary hypertension: Mayo Clinic experience categorized by treatment subgroups. Am J Transplant, 8: 2445–2453, 2008.

    Article  PubMed  CAS  Google Scholar 

  48. Krowka MJ. Evolving dilemmas and management of portopulmonary hypertension. Semin Liver Dis, 26: 265–272, 2006.

    Article  PubMed  Google Scholar 

  49. Kawut SM, Krowka MJ, Trotter JF, Roberts KE, Benza RL, Badesch DB, Taichman DB, Horn EM, Zacks S, Kaplowitz N, Brown RS Jr, and Fallon MB. Clinical risk factors for portopulmonary hypertension. Hepatology, 48: 196–203, 2008.

    Article  PubMed  Google Scholar 

  50. Roberts KE, Fallon MB, Krowka MJ, Brown RS, Trotter JF, Peter I, Tighiouart H, Knowles JA, Rabinowitz D, Benza RL, Badesch DB, Taichman DB, Horn EM, Zacks S, Kaplowitz N, and Kawut S M. Genetic risk factors for portopulmonary hypertension in patients with advanced liver disease. Am J Respir Crit Care Med, 179: 835–842, 2009.

    Article  PubMed  Google Scholar 

  51. Gerbes AL, Moller S, Gulberg V, and Henriksen JH. Endothelin-1 and -3 plasma concentrations in patients with cirrhosis: role of splanchnic and renal passage and liver function. Hepatology, 21: 735–739, 1995.

    PubMed  CAS  Google Scholar 

  52. Machado RD, Eickelberg O, Elliott CG, Geraci MW, Hanaoka M, Loyd JE, Newman JH, Phillips JA 3rd, Soubrier F, Trembath RC, and Chung WK. Genetics and genomics of pulmonary arterial hypertension. J Am Coll Cardiol, 54: S32–42, 2009.

    Article  PubMed  CAS  Google Scholar 

  53. Stauber RE and Olschewski H. Portopulmonary hypertension: short review. Eur J Gastroenterol Hepatol, 22: 385–390.

  54. Kuo PC, Plotkin JS, Johnson LB, Howell CD, Laurin JM, Bartlett ST, and Rubin LJ. Distinctive clinical features of portopulmonary hypertension. Chest, 112: 980–986, 1997.

    Article  PubMed  CAS  Google Scholar 

  55. Bernal V, Pascual I, Esquivias P, Garcia-Gil A, Mateo JM, Lacambra I, Serrano MT, and Simon MA. N-terminal brain natriuretic peptide as a diagnostic test in cirrhotic patients with pulmonary arterial hypertension. Transplant Proc, 41: 987–988, 2009.

    Article  PubMed  CAS  Google Scholar 

  56. Le Pavec J, Souza R, Herve P, Lebrec D, Savale L, Tcherakian C, Jais X, Yaici A, Humbert M, Simonneau G, and Sitbon O. Portopulmonary hypertension: survival and prognostic factors. Am J Respir Crit Care Med, 178: 637–643, 2008.

    Article  PubMed  Google Scholar 

  57. Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, Nakanishi N, and Miyatake K. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med, 161: 487–492, 2000.

    PubMed  CAS  Google Scholar 

  58. Wensel R, Opitz CF, Anker SD, Winkler J, Hoffken G, Kleber FX, Sharma R, Hummel M, Hetzer R, and Ewert R. Assessment of survival in patients with primary pulmonary hypertension: importance of cardiopulmonary exercise testing. Circulation, 106: 319–324, 2002.

    Article  PubMed  Google Scholar 

  59. Kim WR, Krowka MJ, Plevak DJ, Lee J, Rettke SR, Frantz RP, and Wiesner RH. Accuracy of Doppler echocardiography in the assessment of pulmonary hypertension in liver transplant candidates. Liver Transpl, 6: 453–458, 2000.

    Article  PubMed  Google Scholar 

  60. Krowka MJ. Portopulmonary hypertension: diagnostic advances and caveats. Liver Transpl, 9: 1336–1337, 2003.

    PubMed  Google Scholar 

  61. Badesch DB, Champion HC, Sanchez MA, Hoeper MM, Loyd JE, Manes A, McGoon M, Naeije R, Olschewski H, Oudiz RJ, and Torbicki A. Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol, 54: S55–66, 2009.

    Article  PubMed  Google Scholar 

  62. Krowka MJ, Plevak DJ, Findlay JY, Rosen CB, Wiesner RH, and Krom RA. Pulmonary hemodynamics and perioperative cardiopulmonary-related mortality in patients with portopulmonary hypertension undergoing liver transplantation. Liver Transpl, 6: 443–450, 2000.

    Article  PubMed  CAS  Google Scholar 

  63. Bosch J, Garcia-Pagan JC, Berzigotti A, and Abraldes JG. Measurement of portal pressure and its role in the management of chronic liver disease. Semin Liver Dis, 26: 348–362, 2006.

    Article  PubMed  Google Scholar 

  64. Torbicki A. Cardiac magnetic resonance in pulmonary arterial hypertension: a step in the right direction. Eur Heart J, 28: 1187–1189, 2007.

    Article  PubMed  Google Scholar 

  65. Galie N, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J, 30: 2493–2537, 2009.

    Article  PubMed  Google Scholar 

  66. Kalambokis G, Korantzopoulos P, Nikas SA, Theodorou A, and Tsianos EV. Significant improvement of portopulmonary hypertension after 1-week terlipressin treatment. J Hepatol, 48: 678–680, 2008.

    Article  PubMed  CAS  Google Scholar 

  67. Provencher S, Herve P, Jais X, Lebrec D, Humbert M, Simonneau G, and Sitbon O. Deleterious effects of beta-blockers on exercise capacity and hemodynamics in patients with portopulmonary hypertension. Gastroenterology, 130: 120–126, 2006.

    Article  PubMed  CAS  Google Scholar 

  68. Halank M, Miehlke S, Hoeffken G, Schmeisser A, Schulze M, and Strasser RH. Use of oral endothelinreceptor antagonist bosentan in the treatment of portopulmonary hypertension. Transplantation, 77: 1775–1776, 2004.

    Article  PubMed  Google Scholar 

  69. McGoon MD, Frost AE, Oudiz RJ, Badesch DB, Galie N, Olschewski H, McLaughlin VV, Gerber M J, Dufton C, Despain DJ, and Rubin LJ. Ambrisentan therapy in patients with pulmonary arterial hypertension who discontinued bosentan or sitaxsentan due to liver function test abnormalities. Chest, 135: 122–129, 2009.

    Article  PubMed  CAS  Google Scholar 

  70. Sakai T, Planinsic RM, Mathier MA, de Vera ME, and Venkataramanan R. Initial experience using continuous intravenous treprostinil to manage pulmonary arterial hypertension in patients with endstage liver disease. Transpl Int, 22: 554–561, 2009.

    Article  PubMed  CAS  Google Scholar 

  71. Hoeper MM, Seyfarth HJ, Hoeffken G, Wirtz H, Spiekerkoetter E, Pletz MW, Welte T, and Halank M. Experience with inhaled iloprost and bosentan in portopulmonary hypertension. Eur Respir J, 30: 1096–1102, 2007.

    Article  PubMed  CAS  Google Scholar 

  72. Gough MS and White RJ. Sildenafil therapy is associated with improved hemodynamics in liver transplantation candidates with pulmonary arterial hypertension. Liver Transpl, 15: 30–36, 2009.

    Article  PubMed  Google Scholar 

  73. Austin MJ, McDougall NI, Wendon JA, Sizer E, Knisely AS, Rela M, Wilson C, Callender ME, O’ Grady JG, and Heneghan MA. Safety and efficacy of combined use of sildenafil, bosentan, and iloprost before and after liver transplantation in severe portopulmonary hypertension. Liver Transpl, 14: 287–291, 2008.

    Article  PubMed  Google Scholar 

  74. Azoulay D, Castaing D, Dennison A, Martino W, Eyraud D, and Bismuth H. Transjugular intrahepatic portosystemic shunt worsens the hyperdynamic circulatory state of the cirrhotic patient: preliminary report of a prospective study. Hepatology, 19: 129–132, 1994.

    Article  PubMed  CAS  Google Scholar 

  75. Krowka MJ, Mandell MS, Ramsay MA, Kawut SM, Fallon MB, Manzarbeitia C, Pardo M Jr, Marotta P, Uemoto S, Stoffel MP, and Benson JT. Hepatopulmonary syndrome and portopulmonary hypertension: a report of the multicenter liver transplant database. Liver Transpl, 10: 174–182, 2004.

    Article  PubMed  Google Scholar 

  76. Swanson KL and Krowka MJ. Screen for portopulmonary hypertension, especially in liver transplant candidates. Cleve Clin J Med, 75: 121–122, 125–130, 133 passim, 2008.

    Article  PubMed  Google Scholar 

  77. Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, and Simonneau G. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J, 34: 1219–1263, 2009.

    Article  PubMed  CAS  Google Scholar 

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  1. Zentrum für Innere Medizin, Gastroenterologie und Hepatologie, Essen, Germany

    Kerstin Herzer, Ali Canbay & Guido Gerken

  2. II. Medizinische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Germany

    Felix Post

  3. Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Germany

    Kerstin Herzer

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Herzer, K., Post, F., Canbay, A. et al. Pulmonale Affektion bei fortgeschrittener Lebererkrankung – hepatopulmonales Syndrom und portopulmonale Hypertonie. Med Klin 105, 916–923 (2010). https://doi.org/10.1007/s00063-010-1157-9

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