Pulmonary Complications in Cirrhosis: Current Concepts and Clinical Perspectives

The liver and lungs maintain an essential anatomical and physiological network crucial for systemic homeostasis. In the presence of cirrhosis, particularly when accompanied by portal hypertension, this intricate communication is disrupted. The resulting alterations can lead to a range of pulmonary complications through intertwined vascular, immunologic, and mechanical mechanisms that underscore the close relationship between these two organs. This review provides an overview of the liver-lung axis and summarizes current concepts of the pathophysiological processes by which advanced liver disease contributes to major respiratory complications. It also highlights diagnostic principles and clinical manifestations, with emphasis on hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax. Although these conditions differ substantially in their underlying pathogenesis, they share common clinical consequences, including impaired arterial oxygenation, reduced functional capacity, and an increased risk of mortality prior to liver transplantation. In addition, the review explores the ongoing debate regarding the potential association between chronic hepatitis C virus infection and pulmonary fibrosis. Overall, early recognition of these pulmonary complications is crucial, as they have important implications for symptom burden, therapeutic decision-making, liver transplant eligibility, and overall clinical outcomes in patients with chronic liver disease.