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Published on: November 18, 2018
Pulmonary complications in cirrhosis
Norman L Sussman1, Rajan Kochar, Michael B Fallon
1Baylor College of Medicine, Houston, Texas 77030, USA. normans@bcm.edu
Current Opinion in Organ Transplantation
|May 6, 2011
Summary
Cirrhosis can cause two main pulmonary complications: portopulmonary hypertension (POPH) and hepatopulmonary syndrome (HPS). While POPH responds to treatment, HPS is resistant, but both improve with liver transplantation.
Area of Science:
- Pulmonary Medicine
- Hepatology
- Cardiology
Background:
- Cirrhosis is frequently associated with significant pulmonary complications.
- Two primary pulmonary vascular disorders complicate cirrhosis: portopulmonary hypertension (POPH) and hepatopulmonary syndrome (HPS).
Purpose of the Study:
- To review and summarize the pulmonary complications associated with cirrhosis.
- To differentiate the pathophysiology, clinical presentation, and management of POPH and HPS.
Main Methods:
- Literature review of pulmonary complications in cirrhosis.
- Analysis of current definitions and treatment strategies for POPH and HPS.
Main Results:
- Portopulmonary hypertension (POPH) is defined by pulmonary vascular resistance, excluding cardiac disease, and may be treated with various agents, particularly inhaled therapies peri-transplant.
- Hepatopulmonary syndrome (HPS) involves intrapulmonary arteriovenous shunting leading to hypoxemia and is generally refractory to medical therapy.
- Both POPH and HPS are linked to portal hypertension but not directly to its severity or the liver disease itself, and they increase mortality beyond the MELD score.
Conclusions:
- POPH and HPS are distinct pulmonary vascular complications of cirrhosis.
- POPH typically responds to vasodilators, whereas HPS is resistant to medical management.
- Liver transplantation offers improvement or cure for both POPH and HPS.
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