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Pulmonary dysfunction in advanced liver disease: frequent occurrence of an abnormal diffusing capacity
J M Hourani1, P E Bellamy, D P Tashkin
1Department of Medicine, UCLA School of Medicine 90024-1690.
The American Journal of Medicine
|June 1, 1991
Summary
Patients with advanced liver disease frequently exhibit pulmonary function abnormalities, most commonly reduced diffusing capacity for carbon monoxide (DLCO). These lung function changes can impact gas exchange and may be linked to intrapulmonary vascular issues.
Area of Science:
- Pulmonary Medicine
- Hepatology
- Transplantation Medicine
Background:
- Chronic liver disease is associated with various pulmonary function abnormalities.
- Understanding these lung function changes is crucial for patients evaluated for liver transplantation.
Purpose of the Study:
- To define the frequency and nature of pulmonary function abnormalities in patients with severe advanced liver disease undergoing evaluation for liver transplantation.
Main Methods:
- Pulmonary function tests and chest radiographs were performed on 116 patients awaiting liver transplantation.
- Quantitative whole-body technetium-99m macroaggregated albumin perfusion scanning was used in 17 patients to assess intrapulmonary shunting.
Main Results:
- Reduced diffusing capacity for carbon monoxide (DLCO) was the most common abnormality, affecting 48-71% of patients based on smoking status.
- Ventilatory restriction occurred in 25%, airflow obstruction in 3%, and widened alveolar-arterial oxygen gradient in 45% of patients.
- Diffusion impairment with hypoxemia correlated with increased right-to-left shunt fraction, while isolated diffusion impairment did not.
Conclusions:
- Most patients with advanced liver disease have abnormal lung function, with reduced DLCO being the most frequent defect.
- Potential mechanisms include intrapulmonary vascular dilatations, interstitial lung disease, vaso-occlusive disease, and ventilation-perfusion imbalance.