Transplant Proc. 2005 Nov;37(9):3861-3864.


Liver Transplantation in High-Risk Patients: Hepatopulmonary Syndrome and
Portopulmonary Hypertension.

Martinez-Palli G, Taura P, Balust J, Beltran J, Zavala E, Garcia-Valdecasas
JC.

Department of Anesthesiology, Liver Transplant Unit, Hospital Clinic,
University of Barcelona, Barcelona, Spain.

Two pulmonary vascular disorders, considered mutually exclusive, may be
present in candidates for orthotopic liver transplantation (OLT). On the one
hand, hepatopulmonary syndrome (HPS), with a prevalence about 20% in
end-stage liver disease, is characterized by pulmonary vascular dilatation
and abnormal gas exchange. On the other hand, portopulmonary hypertension
(POPH), a process defined by pulmonary hypertension associated with portal
hypertension, is less common than HPS (4%). These entities have very
distinct clinical implications; whereas HPS is clinically characterized by
respiratory symptoms that evolve to severe hypoxemia, patients with POPH are
commonly asymptomatic, frequently diagnosed in the setting of OLT, and the
symptoms appear when there is hemodynamic compromise. The pathogenesis of
both entities is a putative mechanism, the imbalance of vasoactive
substances in pulmonary vessels. The role of OLT to reverse these vascular
disorders is controversial, although complete resolution of HPS and, less
frequently, POPH following OLT has been reported. The recognition that the
presence of both HPS and POPH is an important cause of morbidity and
mortality among recipients of OLT has resulted in a change in the policy to
select OLT candidates. Accurate identification of patients with pulmonary
vascular disorders associated with liver disease should be the first step in
the management of OLT candidates. Because the determinants of the prognosis
of OLT in the setting of these pulmonary vascular changes have not been well
established, an accurate cardiopulmonary evaluation with careful assessment
of pulmonary gas exchange (in HPS) and right ventricular function (in POPH)
of potential OLT recipients is mandatory before the procedure.

PMID: 16386564 [PubMed - as supplied by publisher]





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