Clinical characteristics, predictors, and survival among patients with hepatopulmonary syndrome

Younis, Irfan; Sarwar, Shahid; Butt, Zeeshan; Tanveer, Sheharyar; Qaadir, Adnan; Jadoon, Nauman

doi:10.1016/s1665-2681(19)31275-x

Cited by 42 publications

(36 citation statements)

References 22 publications

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“…The pathogenesis is complicated 1–5. Liver fibrosis increases the production of proinflammatory cytokines, such as endothelin 1 and tumour necrosis factor-A.…”

Section: Discussionmentioning

confidence: 99%

“…Observational studies have shown complete or near-complete resolution of HPS with improved oxygenation and shunt in the majority of patients within the initial 6–12 months with no increased mortality. The discussion of the evidence base behind liver transplantation for patients with HPS and their associated Model for End-stage Liver Disease score is beyond the scope of this case report 1–6…”

Section: Discussionmentioning

confidence: 99%

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Platypnoea and orthodeoxia in the hepatopulmonary syndrome

2019

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A 71-year-old female patient with alcohol-induced cirrhosis presented with symptoms of dyspnoea. Previous extensive investigations had detected no apparent cause. Platypnoea and orthodeoxia were observed. A bubble echocardiogram revealed significant intracardiac shunting and a diagnosis of hepatopulmonary syndrome was made. The patient was discharged on home oxygen and referred for liver transplantation.

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“…The pathogenesis is complicated 1–5. Liver fibrosis increases the production of proinflammatory cytokines, such as endothelin 1 and tumour necrosis factor-A.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Platypnoea and orthodeoxia in the hepatopulmonary syndrome

2019

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“…These discrepancies are mainly attributed to the varying alveolar-arterial gradient and PaO 2 thresholds used for the detection of impaired arterial oxygenation [10]. As a result, the prevalence of HPS is estimated to range from 4-47%, with most recent studies, using the diagnostic criteria proposed by the European Respiratory Society Task Force in 2004 [3], reporting an average of 30% in patients with end-stage liver disease [11][12][13]. The use of the alveolar-arterial gradient as a more sensitive marker of oxygenation abnormalities, combined with the establishment of screening protocols in transplantation candidates, led to higher HPS diagnostic rates, even among asymptomatic patients.…”

Section: Epidemiologymentioning

confidence: 99%

Pulmonary manifestations of chronic liver disease: a comprehensive review

Σουλαϊδόπουλος

Goulis

2020

aog

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Hepatopulmonary syndrome (HPS) and porto-pulmonary hypertension (PoPH) represent relatively common pulmonary vascular complications of advanced liver disease. Despite distinct differences in their pathogenetic background, both clinical states are characterized by impaired arterial oxygenation and limited functional status, and are associated with increased pretransplantation mortality. Accumulation of ascitic fluid in the pleural cavity, known as hepatic hydrothorax (HH), is another frequent manifestation of decompensated cirrhosis, which may cause severe respiratory dysfunction, depending on the volume of the effusion, the rapidity of its development and its resistance to therapeutic measures. Orthotopic liver transplantation constitutes the only effective treatment able to resolve the pulmonary complications of liver disease. A prioritization policy for liver transplantation has evolved over the past years regarding advanced stages of HPS, yielding favorable outcomes regarding post-transplantation survival and HPS resolution. In contrast, severe PoPH is associated with poor post-transplantation survival. Hence, liver transplantation is recommended only for patients with PoPH and an acceptable reduction in pulmonary pressure values, after receiving PoPH-targeted vasodilating therapy. This review focuses on basic pathogenetic and diagnostic principles and discusses the current therapeutic approaches regarding HPS, PoPH, and HH.

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“…Observational studies reported a correlation between the presence of HPS and more severe liver disease. [48,49] The prevalence of HPS among patients with end stage liver disease is about 5-32%. [48,50] Nevertheless, isolated intrapulmonary vascular dilatation can be found in up to 50-60% of patients with liver cirrhosis, but mostly without influencing arterial oxygenation.…”

Section: Spontaneous Bacterial Empyemamentioning

confidence: 99%

Pulmonary complications in patients with liver cirrhosis

Benz

Mohr

Tacke

et al. 2020

Journal of Translational Internal Medicine

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Patients with advanced chronic liver diseases, particularly with decompensated liver cirrhosis, can develop specific pulmonary complications independently of any pre-existing lung disease. Especially when dyspnea occurs in combination with liver cirrhosis, patients should be evaluated for hepato-pulmonary syndrome (HPS), porto-pulmonary hypertension (PPHT), hepatic hydrothorax and spontaneous bacterial empyema, which represent the clinically most relevant pulmonary complications of liver cirrhosis. Importantly, the pathophysiology, clinical features, diagnosis and the corresponding therapeutic options differ between these entities, highlighting the role of specific diagnostics in patients with liver cirrhosis who present with dyspnea. Liver transplantation may offer a curative therapy, including selected cases of HPS and PPHT. In this review article, we summarize the pathogenesis, clinical features, diagnostic algorithms and treatment options of the 4 specific pulmonary complications in patients with liver cirrhosis.

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Clinical characteristics, predictors, and survival among patients with hepatopulmonary syndrome

Cited by 42 publications

References 22 publications

Platypnoea and orthodeoxia in the hepatopulmonary syndrome

Platypnoea and orthodeoxia in the hepatopulmonary syndrome

Pulmonary manifestations of chronic liver disease: a comprehensive review

Pulmonary complications in patients with liver cirrhosis

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