Time-dependent reversal of significant intrapulmonary shunt after liver transplantation

Abstract

Repeated CE is useful to evaluate intrapulmonary vascular change before and after LT. Reversal of IPS after successful LT is time-dependent and follow-up duration should be considered for accurate assessment of IPS after LT.

A Simple and Quick Screening Method for Intrapulmonary Vascular Dilation in Cirrhotic Patients Based on Machine Learning

“… 17 Furthermore, Jin et al . 18 observed that HPS reversed in 95.8% of the liver transplant patients at 6 months; however, the prevalence of IPVD was 69.2% at 6 months, suggesting a difference between HPS and IPVD reversibility. It was also reported that cirrhosis regression induced a significant reduction in portal pressure accompanied by a normalization of systemic hemodynamics; however, there was no change in extrahepatic vascular structures.…”

“…7 IPVD was also found to be associated with a higher prevalence of obstructed intrahepatic portal branches, of slowed or hepatofugal portal blood flow, and of large abdominal portosystemic shunts, 15 which was in accordance with the intra-and extrahepatic vasculature changes in cirrhosis. 17 Furthermore, Jin et al 18 observed that HPS reversed in 95.8% of the liver transplant patients at 6 months; however, the prevalence of IPVD was 69.2% at 6 months, suggesting a difference between HPS and IPVD reversibility. It was also reported that cirrhosis regression induced a significant reduction in portal pressure accompanied by a normalization of systemic hemodynamics; however, there was no change in extrahepatic vascular structures.…”

“… 22 Although some laboratory indicators showed significant differences between IPVD and non-IPVD patients, we found that routine laboratory indicators alone were not good indicators for IPVD, which is constant with previously reported findings. 7 , 18 We also attempted to use noninvasive variables and ABG results to develop one-step models for screening for the presence of IPVD in cirrhotic patients, with unsatisfactory results (shown in Supplementary Table 6 ). Previous studies and our results suggest that it would be more practical to combine variables rather than using single variables for model construction.…”

“…The prevalence of IPVD varies from 20.7% to 84.0% due to differences in the study populations. 7 , 10 , 18 , 23 , 24 However, IPVD patients with abnormal gas exchange, with a prevalence of approximately 30%, 25 should not be overlooked and need intervention. Thus, the adjusted PPV and NPV were 73.8% and 94.2% for both the NI and NIBG model, respectively, for the whole model, when the prevalence of positive cases was 30%.…”

Hepatopulmonary syndrome delays postoperative recovery and increases pulmonary complications after hepatectomy

“…This suggests that IPVD, HPS subclinical stage, was likely to be beneficial for the early postoperative recovery of patients, which may be related to the reduction of high pulmonary artery pressure due to mild microvascular dilation. Moreover, about 35% of IPVD patients would develop into HPS over time [35], and the reversibility of IPVD was also different from HPS [36]. The above differences between HPS and IPVD may cause the difference in postoperative recovery and serum changes of cytokines.…”