title: The hepatopulmonary syndrome.
abstract: BACKGROUND
  The hepatopulmonary syndrome has been acknowledged as an important vascular complication in lungs developing systemic hypoxemia in patients with cirrhosis and portal hypertension. Is formed by arterial oxygenation abnormalities induced from intrapulmonary vascular dilatations with liver disease. It is present in 4-32% of patients with cirrhosis. It increases mortality in the setting of cirrhosis and may influence the frequency and severity. Initially the hypoxemia responds to low-flow supplemental oxygen, but over time, the need for oxygen supplementation is necessary. The liver transplantation is the only effective therapeutic option for its resolution.
  
  
  OBJECTIVE
  To update clinical manifestation, diagnosis and treatment of this entity.
  
  
  METHODS
  A literature review was performed on management of hepatopulmonary syndrome. The electronic search was held of the Medline-PubMed, in English crossing the headings "hepatopulmonary syndrome", "liver transplantation" and "surgery". The search was completed in September 2013.
  
  
  RESULTS
  Hepatopulmonary syndrome is classically defined by a widened alveolar-arterial oxygen gradient (AaPO2) on room air (>15 mmHg, or >20 mmHg in patients >64 years of age) with or without hypoxemia resulting from intrapulmonary vasodilatation in the presence of hepatic dysfunction or portal hypertension. Clinical manifestation, diagnosis, classification, treatments and outcomes are varied.
  
  
  CONCLUSIONS
  The severity of hepatopulmonary syndrome is an important survival predictor and determine the improvement, the time and risks for liver transplantation. The liver transplantation still remains the only effective therapeutic.
authors.affiliation: Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Lucas Souto
authors.initials: LS
authors.lastname: Nacif
authors.affiliation: Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Wellington
authors.initials: W
authors.lastname: Andraus
authors.affiliation: Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Rafael Soares
authors.initials: RS
authors.lastname: Pinheiro
authors.affiliation: Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Liliana
authors.initials: L
authors.lastname: Ducatti
authors.affiliation: Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Luciana B P
authors.initials: LB
authors.lastname: Haddad
authors.affiliation: Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Luiz Carneiro
authors.initials: LC
authors.lastname: D'Albuquerque
mesh_terms: D000465:Algorithms; D020065:Hepatopulmonary Syndrome / Q000175:diagnosis / Q000628:therapy; D006801:Humans