Hepatopulmonary Syndrome and Portopulmonary Hypertension

This article reviews the pathophysiology, diagnosis, and management of portopulmonary hypertension (PoPH) and hepatopulmonary syndrome (HPS) in liver transplant candidates. PoPH is characterized by elevated pulmonary pressures and vascular remodeling, with implications for transplant eligibility based on hemodynamic criteria. HPS, marked by intrapulmonary vascular dilations, results in hypoxemia, often requiring liver transplantation as the only curative therapy. Screening protocols, particularly the role of echocardiography and right heart catheterization, are discussed alongside pulmonary arterial hypertension-targeted therapies. The paper emphasizes the importance of monitoring and managing pulmonary pressures pretransplant and posttransplant to improve outcomes and reduce posttransplant mortality risk.