Both authors contributed equally to this work.The prevalence of hepatopulmonary syndrome (HPS) and its influence on survival before and after liver transplantation (LT) remain controversial. Additionally, the chronology of post-LT reversibility is unclear. This study prospectively analyzed 316 patients with cirrhosis who were evaluated for LT in 2002LT in -2007 177 underwent LT at a single reference hospital. HPS was defined by a partial pressure of arterial oxygen (PaO 2 ) <70 mmHg and/or an alveolar-arterial oxygen gradient (A-a PO 2 ) !20 mmHg in the supine position and positive contrast echocardiography. The prevalence of HPS was 25.6% (81/316 patients), and most patients (92.6%) had mild or moderate HPS. High Child-Pugh scores and the presence of ascites were independently associated with HPS. Patients with and without HPS did not significantly differ in LT waiting list survival (mean 34.6 months vs. 41.6 months, respectively; logrank, p ¼ 0.13) or post-LT survival (mean 45 months vs. 47.6 months, respectively; log-rank, p ¼ 0.62). HPS was reversed in all cases within 1 year after LT. One-fourth of the patients with cirrhosis who were evaluated for LT had HPS (mostly mild to moderate); the presence of HPS did not affect LT waiting list survival. HPS was always reversed after LT, and patient prognosis did not worsen. Hepatopulmonary syndrome (HPS) is characterized by blood oxygen changes that are caused by pulmonary vascular dilations in patients with liver disease (1,2). The criteria that are used to define HPS and the reported prevalence of HPS in patients with liver cirrhosis and in candidates for liver transplantation (LT) vary widely in the literature (4-32%) (3-7). The cause of HPS is unknown, and the association between liver dysfunction and portal hypertension remains controversial, as reported by different studies (4-10). Orthodeoxia is considered to be characteristic of HPS; however, the prevalence of this condition in patients with HPS is only 25% (1,11).The association between HPS and increased mortality in patients with cirrhosis who are candidates for LT has been disputed. A recent prospective multicenter study identified associations between HPS, independent of its severity, and increased mortality and poorer quality of life (7). Other studies of HPS and LT were retrospective (12) or were based on small sample sizes (6).LT is the treatment of choice for HPS. Early results of LT in patients with HPS have been disappointing and have

Objectives: to assess the efficacy of thalidomide in the treatment of relapsed or refractory bleeding secondary to gastrointestinal angiodysplasia. Material and methods: we carried out a prospective study of 12 patients with bleeding due to gastrointestinal angiodysplasia refractory to conventional therapy who were treated with thalidomide. For each patient, we considered: age, sex, underlying disease, previous therapies, dose and duration of thalidomide treatment, evolution of haemoglobin levels and adverse effects of treatment. The data obtained were analysed using descriptive statistics with SPSS v. 16. Results: seven men and 5 women with a mean age of 77 years were included in the present study. Five had some underlying pathology and all of them had received prior endoscopic/octreotide treatment. The dose of thalidomide administered was 200 mg/24 h and the duration of the treatment four months, with the exception of two patients in whom treatment was discontinued because of adverse side effects. Mean haemoglobin concentration before onset of treatment was 6.5 g/dL, at two months it was 11.3 g/dL and at the end of treatment 12.1 g/dL. Conclusions: thalidomide is an effective treatment in gastrointestinal bleeding due to angiodysplasia, but it was withdrawn due to side effects in 16% of the patients included in our study.

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