Recent advances in the approach to hepatopulmonary syndrome and portopulmonary hypertension
| Autor: | H. Van Vlierberghe, Isabelle Colle, Sarah Raevens, Lindsey Devisscher, A. Geerts, C. Van Steenkiste |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Liver Cirrhosis medicine.medical_specialty Cirrhosis medicine.medical_treatment Hypertension Pulmonary Liver transplantation 03 medical and health sciences Liver disease 0302 clinical medicine Internal medicine Hypertension Portal medicine Humans Hepatopulmonary syndrome Survival rate Portopulmonary hypertension Pulmonary Arterial Hypertension Vascular disease business.industry medicine.disease 030104 developmental biology Cardiology Portal hypertension 030211 gastroenterology & hepatology business Hepatopulmonary Syndrome |
| Zdroj: | Acta gastro-enterologica Belgica. 84(1) |
| ISSN: | 1784-3227 |
| Popis: | Liver disease, cirrhosis and portal hypertension can be complicated by pulmonary vascular disease, which may affect prognosis and influence liver transplantation (LT) candidacy. Pulmonary vascular complications comprise hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH). Although these two conditions develop on a same background and share a common trigger, pulmonary responses are distinct and occur at different anatomical sites of the pulmonary circulation. HPS affects 10-30% of patients referred for LT, and is characterized by gas exchange abnormalities due to pulmonary vasodilation and right-to-left shunting. POPH occurs in 5%, and is defined by pulmonary arterial hypertension due to increased pulmonary vascular resistance, which leads to hemodynamic failure. Even though HPS and POPH may have a substantial negative impact on survival, both entities are clinically underrecognized and frequently misdiagnosed. Without intervention, the 5-year survival rate is 23% in HPS and 14% in POPH. Their presence should be actively sought by organized screening in patients presenting with dyspnea and in all patients on the waitlist for LT, also because clinical symptoms are commonly non-specific or even absent. LT may lead to resolution, however, advanced stages of either HPS or POPH may jeopardize safe and successful LT. This implicates the need of proper identification of HPS and POPH cases, as well as the need to be able to successfully ‘bridge’ patients to LT by medical intervention. A review article on this topic has been published in this journal in 2007 (1). This updated review focuses on recent advances in the diagnosis and management of these 2 liver-induced pulmonary vascular disorders and incorporates results from our recent work. |
| Databáze: | OpenAIRE |
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