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Hepatopulmonary syndrome.

Miguel R Arguedas1, Michael B Fallon

  • 1Department of Medicine, Division of Gastroenterology/Hepatology, University of Alabama at Birmingham, MCLM 290, 1530 3rd Avenue South, Birmingham, AL 35294, USA.

Current Treatment Options in Gastroenterology
|November 30, 2005
PubMed
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Hepatopulmonary syndrome (HPS) is a serious complication of cirrhosis, causing low oxygen levels and increasing mortality risk. Orthotopic liver transplantation (OLT) can reverse HPS, but pharmacologic therapies and oxygen may help manage symptoms.

Area of Science:

  • Cardiology
  • Pulmonology
  • Hepatology

Background:

  • Hepatopulmonary syndrome (HPS) is a vascular complication of cirrhosis and portal hypertension.
  • HPS is characterized by pulmonary vascular dilatation leading to hypoxemia.
  • It affects up to 20% of patients evaluated for orthotopic liver transplantation (OLT) and increases mortality.

Purpose of the Study:

  • To review the current understanding and management of hepatopulmonary syndrome (HPS).
  • To discuss the role of OLT and potential pharmacologic therapies for HPS.

Main Methods:

  • Review of existing literature, case reports, and experimental models.
  • Analysis of the impact of hypoxemia severity on OLT outcomes.

Main Results:

Related Experiment Videos

  • OLT is the only established therapy to reverse HPS-related intrapulmonary vasodilatation.
  • Severe hypoxemia increases postoperative mortality in OLT recipients.
  • Supplemental oxygen improves oxygenation in HPS patients.

Conclusions:

  • OLT should be considered for cirrhotic patients with HPS and moderate hypoxemia before severe deoxygenation occurs.
  • Supplemental oxygen is recommended for patients with PaO2 < 60 mmHg or exercise desaturation.
  • Pharmacologic treatment may be a viable option for mild hypoxemia or non-OLT candidates.