Inhaled iloprost for hepatopulmonary syndrome: improvement of hypoxemia

Krug, Sabine; Seyfarth, HJ; Hagendorff, Andreas; Wirtz, Hubert

doi:10.1097/meg.0b013e328220ed72

Cited by 32 publications

(12 citation statements)

References 26 publications

(24 reference statements)

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“…Inhaled iloprost is an alternative form of PGI 2 which is approved for the treatment of pulmonary hypertension. Inhaled iloprost has been applied for the treatment of HPS in posttransplant period and was outlined to be effective in the improvement of clinical symptoms and hypoxemia [82]. …”

Section: Resultsmentioning

confidence: 99%

Pharmacological Treatment for Hepatopulmonary Syndrome

Eshraghian

Kamyab

Yoon

2013

BioMed Research International

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Aim. Hepatopulmonary syndrome is a pulmonary dysfunction in the context of liver cirrhosis characterized by arterial deoxygenation. Affected patients have increased morbidity and mortality, and many of them expire before undergoing liver transplantation. Therefore, finding medical therapy as a bridge to transplantation or as a final treatment is necessary. In this study, we aimed to review the current literature about pharmacological options available for treatment of hepatopulmonary syndrome. Methods. A PubMED and Scopus search was conducted in January 2013 on the English literature published in any time period to find human and animal studies reporting pharmacological therapy of hepatopulmonary syndrome. Results. Out of 451 studies, 29 relevant articles were included. The number of patients, type, dose, duration, and mechanism of drugs in these studies was extracted and summarized separately. Most of pharmacologic agents act through inhibition of nitric oxide synthase and reduction in nitric oxide production, inactivation of endothelin-1, and treatment of bacterial translocation and pulmonary angiogenesis. Conclusion. Several drugs have been applied for the treatment of HPS with conflicting results. However, no large randomized trial has been conducted probably due to low number of patients. Multicentered clinical trials are necessary to investigate these drugs.

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Section: Resultsmentioning

confidence: 99%

Pharmacological Treatment for Hepatopulmonary Syndrome

Eshraghian

Kamyab

Yoon

2013

BioMed Research International

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“…Inhaled epoprostenol likely acts through a mechanism similar to that of iNO 33, and is similarly fast‐ and short‐acting, with a half life of approximately 5 min 34. Although clinical experience with inhaled epoprostenol in HPS is limited (Table 1), it was used successfully in all four reported HPS patients posttransplant.…”

Section: Rationale and Considerations For Included Therapiesmentioning

confidence: 99%

Proposed Management Algorithm for Severe Hypoxemia After Liver Transplantation in the Hepatopulmonary Syndrome

Nayyar

Man

Granton

et al. 2015

American Journal of Transplantation

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The hepatopulmonary syndrome (HPS) is defined as the triad of liver disease, intrapulmonary vascular dilatation, and abnormal gas exchange, and is found in 10–32% of patients with liver disease. Liver transplantation is the only known cure for HPS, but patients can develop severe posttransplant hypoxemia, defined as a need for 100% inspired oxygen to maintain a saturation of ≥85%. This complication is seen in 6–21% of patients and carries a 45% mortality. Its management requires the application of specific strategies targeting the underlying physiologic abnormalities in HPS, but awareness of these strategies and knowledge on their optimal use is limited. We reviewed existing literature to identify strategies that can be used for this complication, and developed a clinical management algorithm based on best evidence and expert opinion. Evidence was limited to case reports and case series, and we determined which treatments to include in the algorithm and their recommended sequence based on their relative likelihood of success, invasiveness, and risk. Recommended therapies include: Trendelenburg positioning, inhaled epoprostenol or nitric oxide, methylene blue, embolization of abnormal pulmonary vessels, and extracorporeal life support. Availability and use of this pragmatic algorithm may improve management of this complication, and will benefit from prospective validation.

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“…Norfloxacin was shown not to be effective in one randomized blinded crossover trial in nine patients (Gupta et al 2010). Anecdotal case reports have documented a beneficial response from inhaled nitric oxide (Durand et al 1998) as well as inhaled iloprost (Krug et al 2007). These agents probably work by redistributing ventilation perfusion imbalances in the lung by causing a generalized pulmonary vasodilatation.…”

Section: Management and Treatmentmentioning

confidence: 99%

Hepatopulmonary Syndrome and Portopulmonary Hypertension

Cartin‐Ceba¹,

Iyer²,

Krowka³

2014

Contemporary Liver Transplantation

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Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH) are pulmonary vascular complications of portal hypertension with or without cirrhosis. The prevalence among liver transplant candidates is roughly 5-32 % for HPS and approximately 6 % for POPH. Although these two conditions may initially present with dyspnea and are pathologically linked by the presence of portal hypertension, their pathophysiologic mechanisms are significantly different. HPS is characterized by low pulmonary vascular resistance secondary to intrapulmonary vascular dilatations and hypoxemia; on the other hand, POPH features elevated pulmonary vascular resistance and constriction of the pulmonary vasculature. Medical treatment for HPS has been disappointing overall. POPH patients can be treated with pulmonary artery-specific vasodilatory therapy. Whereas liver transplantation (LT) results in the resolution of HPS and is an indication per se for LT, its effect on POPH is highly unpredictable. LT poses a high risk of death in those with significant POPH, where pulmonary artery-specific vasodilatory therapy may improve functional status and allow successful LT in a small number of select patients. Modern strategies in managing HPS and POPH rely on a thorough screening and grading of the disease's severity, in order to tailor the appropriate therapy and select only the patients who will benefit from LT.

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Inhaled iloprost for hepatopulmonary syndrome: improvement of hypoxemia

Cited by 32 publications

References 26 publications

Pharmacological Treatment for Hepatopulmonary Syndrome

Pharmacological Treatment for Hepatopulmonary Syndrome

Proposed Management Algorithm for Severe Hypoxemia After Liver Transplantation in the Hepatopulmonary Syndrome

Hepatopulmonary Syndrome and Portopulmonary Hypertension

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