title: Portopulmonary hypertension and hepatopulmonary syndrome.
abstract: Portopulmonary hypertension (POPH) and hepatopulmonary syndrome (HPS) are two frequent complications of liver disease, with prevalence among liver transplant candidates of 6% and 10%, respectively. Both conditions result from a lack of hepatic clearance of vasoactive substances produced in the splanchnic territory. Subsequently, these substances cause mainly pulmonary vascular remodeling and some degree of vasoconstriction in POPH with resulting elevated pulmonary pressure and right ventricular dysfunction. In HPS the vasoactive mediators cause intrapulmonary shunts with hypoxemia. Medical treatment is disappointing overall. Whereas liver transplantation (LT) results in the disappearance of HPS within six to twelve months, its effect on POPH is highly unpredictable. 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. The anesthesiologist plays a central role in managing these high-risk patients. Indeed, the important hemodynamic and respiratory modifications of the perioperative period must be avoided through continuation of the preoperatively initiated drugs, appropriate intraoperative monitoring and proper hemodynamic and respiratory therapies.
authors.affiliation: Florence Aldenkortt, Marc Aldenkortt, Laurence Caviezel, Jean Luc Waeber, Anne Weber, Eduardo Schiffer, Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology and Intensive Care, Geneva University Hospitals, 1211 Geneva, Switzerland.
authors.forename: Florence
authors.initials: F
authors.lastname: Aldenkortt
authors.affiliation: Florence Aldenkortt, Marc Aldenkortt, Laurence Caviezel, Jean Luc Waeber, Anne Weber, Eduardo Schiffer, Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology and Intensive Care, Geneva University Hospitals, 1211 Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Aldenkortt
authors.affiliation: Florence Aldenkortt, Marc Aldenkortt, Laurence Caviezel, Jean Luc Waeber, Anne Weber, Eduardo Schiffer, Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology and Intensive Care, Geneva University Hospitals, 1211 Geneva, Switzerland.
authors.forename: Laurence
authors.initials: L
authors.lastname: Caviezel
authors.affiliation: Florence Aldenkortt, Marc Aldenkortt, Laurence Caviezel, Jean Luc Waeber, Anne Weber, Eduardo Schiffer, Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology and Intensive Care, Geneva University Hospitals, 1211 Geneva, Switzerland.
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Waeber
authors.affiliation: Florence Aldenkortt, Marc Aldenkortt, Laurence Caviezel, Jean Luc Waeber, Anne Weber, Eduardo Schiffer, Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology and Intensive Care, Geneva University Hospitals, 1211 Geneva, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Weber
authors.affiliation: Florence Aldenkortt, Marc Aldenkortt, Laurence Caviezel, Jean Luc Waeber, Anne Weber, Eduardo Schiffer, Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology and Intensive Care, Geneva University Hospitals, 1211 Geneva, Switzerland.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Schiffer
mesh_terms: D000758:Anesthesia / Q000009:adverse effects; D000818:Animals; D062186:Arterial Pressure; D020065:Hepatopulmonary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects; D018579:Patient Selection; D017082:Portal Pressure; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Anesthesia; End stage liver disease; Hepatopulmonary syndrome; Portopulmonary Hypertension