Impact of Hepatopulmonary Syndrome on Quality of Life and Survival in Liver Transplant Candidates

Fallon, Michael B.; Krowka, Michael J.; Brown, Robert S.; Trotter, James F.; Zacks, Steven; Roberts, Kari E.; Shah, Vijay H.; Kaplowitz, Neil; Forman, Lisa; Wille, Keith; Kawut, Steven M.

doi:10.1053/j.gastro.2008.06.038

Cited by 261 publications

(315 citation statements)

References 22 publications

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“…Some authors have suggested that the SA is most commonly seen in patients with the HPS (1,3,18,27,28) , although other authors have not found the same relationship (13,24) . In the classic story of Rydell and Hoffbauer (18) the authors have called attention to the fact that the vast majority of cirrhotic patients with cyanosis and digital clubbing associated exhibit one or more vascular stigmas of cirrhosis, especially SA (18) .…”

Section: Discussionmentioning

confidence: 99%

Are the Spider Angiomas Skin Markers of Hepatopulmonary Syndrome?

Silvério

Guimarães

Elias

et al. 2013

Arq. Gastroenterol.

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Context Hepatopathies can significantly influence both veins and arteries, these changes may cause some cutaneous stigmas, such as spider angioma (SA) and some systemic vascular changes, such as those observed in hepatopulmonary syndrome (HPS). Based on this common pathophysiological root we can assume that the SA can be skin markers of HPS. Objective The objective of this study is to assess whether there is a relationship between the presence of SA and HPS. Methods Records of 40 patients with liver cirrhosis who underwent contrast echocardiography were evaluated, in which we researched the description of SA, physical examination, and other clinical and laboratory data. For diagnosis of HPS we use these signs of the disease: presence of liver disease (cirrhosis in the case), abnormalities in gas exchange by arterial blood gases, and evidence of pulmonary vasodilations by the contrast echocardiography. Results The SA were found in 21/40 (52.5%) patients and hepatopulmonary syndrome in 9/40 (22.5%). The HPS was observed in 8/21 (38.1%) of patients with SA and 1/19 (5.3%) patients were without this sign (P<0.01). We found no statistically significant difference between the SA and the presence of HPS with sex or age. Patients with SA had a higher hypoxemia [PaO2 84.8 ± 11.5 mmHg and 19.8 ± 14.7 mmHg alveolar-arterial gradient of oxygen (AAG)] than those without SA (PaO2 90.8 ± 10.7 mmHg and 10.9 ± 11.7 AAG mmHg) (P<0.05). Conclusion Our findings show a correlation between the presence of SA and HPS, suggesting that the SA may be cutaneous markers of HPS.

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Section: Discussionmentioning

confidence: 99%

Are the Spider Angiomas Skin Markers of Hepatopulmonary Syndrome?

Silvério

Guimarães

Elias

et al. 2013

Arq. Gastroenterol.

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“…Shunting occurs due to precapillary and postcapillary dilatation of the pulmonary microvasculature, as well as by the formation of new blood vessels. 39,47,48 HPS may occur in at least 10% of all patients with cirrhosis and portal hypertension, and in one third of patients evaluated for liver transplantation. [47][48][49] HPS is a diagnosis of exclusion, and none of the teats are specific for its diagnosis.…”

Section: Correct Answers: a B C And Ementioning

confidence: 99%

“…39,47,48 HPS may occur in at least 10% of all patients with cirrhosis and portal hypertension, and in one third of patients evaluated for liver transplantation. [47][48][49] HPS is a diagnosis of exclusion, and none of the teats are specific for its diagnosis. Presence of IPVDs may be seen in up to 60% of patients with cirrhosis, and their presence without hypoxemia is not associated with adverse events.…”

Section: Correct Answers: a B C And Ementioning

confidence: 99%

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Hepatobiliary Quiz (Answers)—16 (2015)

Rathi

Dhiman

2015

Journal of Clinical and Experimental Hepatology

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“…This disease is associated with progressive hypoxemia and a high mortality 3, 5. Although liver transplantation (LT) is curative in HPS, these patients have an elevated postoperative complication rate 6, 7, 8, 9.…”

Section: Introductionmentioning

confidence: 99%

Proposed Management Algorithm for Severe Hypoxemia After Liver Transplantation in the Hepatopulmonary Syndrome

Nayyar

Man

Granton

et al. 2015

American Journal of Transplantation

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The hepatopulmonary syndrome (HPS) is defined as the triad of liver disease, intrapulmonary vascular dilatation, and abnormal gas exchange, and is found in 10–32% of patients with liver disease. Liver transplantation is the only known cure for HPS, but patients can develop severe posttransplant hypoxemia, defined as a need for 100% inspired oxygen to maintain a saturation of ≥85%. This complication is seen in 6–21% of patients and carries a 45% mortality. Its management requires the application of specific strategies targeting the underlying physiologic abnormalities in HPS, but awareness of these strategies and knowledge on their optimal use is limited. We reviewed existing literature to identify strategies that can be used for this complication, and developed a clinical management algorithm based on best evidence and expert opinion. Evidence was limited to case reports and case series, and we determined which treatments to include in the algorithm and their recommended sequence based on their relative likelihood of success, invasiveness, and risk. Recommended therapies include: Trendelenburg positioning, inhaled epoprostenol or nitric oxide, methylene blue, embolization of abnormal pulmonary vessels, and extracorporeal life support. Availability and use of this pragmatic algorithm may improve management of this complication, and will benefit from prospective validation.

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Impact of Hepatopulmonary Syndrome on Quality of Life and Survival in Liver Transplant Candidates

Abstract: Background & Aims-Hepatopulmonary syndrome (HPS) affects 10%-30% of patients with cirrhosis and portal hypertension, but the impact on functional status, quality of life, and survival is poorly defined. We assessed the impact of HPS in patients evaluated for liver transplantation.

Cited by 261 publications

References 22 publications

Are the Spider Angiomas Skin Markers of Hepatopulmonary Syndrome?

Are the Spider Angiomas Skin Markers of Hepatopulmonary Syndrome?

Hepatobiliary Quiz (Answers)—16 (2015)

Proposed Management Algorithm for Severe Hypoxemia After Liver Transplantation in the Hepatopulmonary Syndrome

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