Management of Hepatopulmonary Syndrome and Portopulmonary Hypertension

Victor I. Machicao, Michael B. Fallon

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Hepatopulmonary syndrome (HPS) is seen in 20-30% of cirrhotics undergoing liver transplantation (LT) evaluation, and has been associated with worse survival. Pulse oximetry and contrast-enhanced transthoracic echocardiography are the most effective screening tests for HPS in LT candidates. LT is the only available treatment for this condition. Portopulmonary hypertension (POPH) is present in 6% of cirrhotics evaluated for LT. Transthoracic Doppler echocardiography is the best screening test for POPH, requiring right-heart catheterization for confirmation if the estimated right ventricular systolic pressure is higher than 40. LT is indicated for patients with a mean pulmonary arterial pressure (mPAP) <35 mmHg, or baseline pressure between 35-45 mmHg, achieving sustained mPAP <35 while on medical treatment.

Original languageEnglish (US)
Title of host publicationMedical Care of the Liver Transplant Patient
Subtitle of host publication4th Edition
PublisherWiley-Blackwell
Pages51-61
Number of pages11
ISBN (Print)9781444335910
DOIs
StatePublished - Mar 28 2012
Externally publishedYes

Keywords

  • Contrast-enhanced transthoracic echocardiography
  • Hepatopulmonary syndrome
  • Hypoxemia
  • MELD exception
  • Portopulmonary hypertension
  • Transthoracic doppler echocardiography

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Machicao, V. I., & Fallon, M. B. (2012). Management of Hepatopulmonary Syndrome and Portopulmonary Hypertension. In Medical Care of the Liver Transplant Patient: 4th Edition (pp. 51-61). Wiley-Blackwell. https://doi.org/10.1002/9781444398441.ch5