Hepatopulmonary syndrome and portopulmonary hypertension: recent knowledge in pathogenesis and overview of clinical assessment

Liver Int. 2015 Jun;35(6):1646-60. doi: 10.1111/liv.12791. Epub 2015 Feb 16.

Abstract

Hepatopulmonary syndrome and portopulmonary hypertension are cardiopulmonary complications, which are not infrequently seen in patients with liver disease and/or portal hypertension. These entities are both clinically and pathophysiologically different: the hepatopulmonary syndrome is characterized by abnormal pulmonary vasodilation and right-to-left shunting resulting in gas exchange abnormalities, whereas portopulmonary hypertension is caused by pulmonary artery vasoconstriction leading to hemodynamic failure. As both hepatopulmonary syndrome and portopulmonary hypertension are associated with significantly increased morbidity and mortality, and as these patients are commonly asymptomatic, all liver transplantation candidates should be actively screened for the presence of these two complications. The aim of is this review is to provide an overview on the hepatopulmonary syndrome and portopulmonary hypertension with primary focus on diagnosis and recent knowledge regarding pathogenesis and therapeutic targets.

Keywords: hepatopulmonary syndrome; liver disease; portopulmonary hypertension.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Endothelin Receptor Antagonists / therapeutic use
  • Hemodynamics
  • Hepatopulmonary Syndrome / diagnosis*
  • Hepatopulmonary Syndrome / pathology
  • Hepatopulmonary Syndrome / therapy
  • Humans
  • Hypertension, Portal / diagnosis*
  • Hypertension, Portal / pathology
  • Hypertension, Pulmonary / diagnosis*
  • Hypertension, Pulmonary / pathology
  • Hypertension, Pulmonary / therapy
  • Liver Transplantation
  • Phosphodiesterase 5 Inhibitors / therapeutic use
  • Prognosis
  • Prostaglandins I / therapeutic use
  • Vasodilation / drug effects

Substances

  • Endothelin Receptor Antagonists
  • Phosphodiesterase 5 Inhibitors
  • Prostaglandins I