title: Portopulmonary hypertension and hepatopulmonary syndrome: a clinician-oriented overview.
abstract: Liver disease and portal hypertension can be associated with pulmonary vascular complications, including portopulmonary hypertension (POPH), characterised by an elevated mean pulmonary artery pressure secondary to an increased pulmonary vascular resistance, and hepatopulmonary syndrome (HPS), characterised by hypoxaemia due to pulmonary vasodilatation and shunting. Although clear diagnostic guidelines exist for both conditions on the basis of echocardiography, right heart catheterisation and arterial blood gases, there is considerable variation between centres regarding diagnosis and management of these conditions. Awareness of evaluation and management algorithms for POPH and HPS are critical for optimisation of outcomes in patients with these conditions. Key aspects of management of POPH and HPS include identification of patients likely to benefit from liver transplantation (LTx) and management before and after LTx. Although both disorders may improve after LTx, severe forms of POPH represent a contraindication to LTx. Novel approaches to the treatment of POPH and HPS offer new management options that may expand the pool of transplantable patients and improve overall outcomes.
authors.affiliation: Dept of Internal Medicine, Division of Hospital Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA.
authors.forename: Mateo
authors.initials: M
authors.lastname: Porres-Aguilar
authors.forename: Jose T
authors.initials: JT
authors.lastname: Altamirano
authors.forename: Aldo
authors.initials: A
authors.lastname: Torre-Delgadillo
authors.forename: Michael R
authors.initials: MR
authors.lastname: Charlton
authors.forename: Andres
authors.initials: A
authors.lastname: Duarte-Rojo
mesh_terms: D062186:Arterial Pressure; D006439:Hemodynamics; D020065:Hepatopulmonary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D008102:Liver Circulation; D011379:Prognosis; D011652:Pulmonary Circulation; D012307:Risk Factors; D014655:Vascular Resistance; D014664:Vasodilation