Pulmonary vascular morphological changes in cirrhotic patients undergoing liver transplantation

Abstract

Cirrhosis and portal hypertension may be associated with pulmonary hypertension and pulmonary dysfunction. However, morphological pulmonary vascular lesions in patients with cirrhosis have not been well characterized morphometrically. We morphometrically evaluated pulmonary vessels in liver transplant recipients with pretransplantation cirrhosis and correlated our findings with pretransplantation cardiopulmonary function, postoperative course, and postmortem cardiopulmonary findings. Autopsy lung slides from 23 transplant recipients with pretransplantation cirrhosis were examined. External vessel diameter, intimal thickness, and arterial medial thickness were measured with a micrometer after pentachrome staining. The percent of total diameter comprised by intima or media was calculated for each vessel. Medical records were reviewed for smoking history, pretransplantation cardiopulmonary function testing, and postoperative course. Autopsy cases without liver or significant cardiopulmonary diseases, matched for age, sex, and smoking history, served as controls. Transplant recipients had significantly more pulmonary venous intimal thickening than matched controls (P F .0001). Sixty-five percent (15 of 23) of these patients had some degree of pretransplantation pulmonary dysfunction, defined by abnormalities in pulmonary function tests, oxygen saturation, and/or increased pulmonary artery pressures. However, the severity of venous intimal thickening did not correlate with the severity of pretransplantation pulmonary dysfunction. Arterial intimal and medial thickness were not statistically significantly different from controls. Pulmonary venous intimal thickening and resultant luminal impingement are morphological findings not previously described in this population. The arterial lesion, when present, is similar to that seen in pulmonary hypertension from other causes. These pulmonary vascular lesions may be implicated in pulmonary dysfunction in patients with cirrhosis and may be associated with increased posttransplantation cardiopulmonary morbidity and mortality. Copyright 1999 by the American Association for the Study of Liver Diseases S evere chronic liver disease, especially cirrhosis with concomitant portal hypertension, has been associated with numerous pulmonary abnormalities, including hypoxemia, decreased diffusion capacity, intrapulmonary and portopulmonary shunting, ventilation/perfusion mismatch, pleural vascular anomalies, and pulmonary hypertension. These pathological pulmonary conditions in patients with cirrhosis have been well documented in the absence of other intrinsic cardiac and pulmonary diseases. 1-7 Between 30% to 70% of the patients with cirrhosis are reportedly hypoxemic; 0.25% to 12.5% of the patients with advanced liver disease have clinical evidence of pulmonary hypertension, with higher percentages reported in studies using right cardiac catheterization. 1,4,[6][7][8][9][10] The natural history of this association between portal hypertension and pulmonary dysfunction in patients with c...

Evaluation of pulmonary arterial stiffness and comparison with right ventricular functions in patients with cirrhosis preparing for liver transplantation

“…21,22 The incidence of PH in patients with advanced chronic liver disease is about 20%. 23,24 In a study, it was determined that approximately 70% of PH seen in cirrhotic patients is associated with hyperdynamic circulation 25 . In addition, POPH and HPS are important vascular complications associated with a markedly increased mortality in patients with cirrhosis.…”

Alterações pulmonares cintilográficas e espirométricas em pacientes jovens portadores de esquistossomose mansônica tratados clínica e cirurgicamente na infância

“…O reconhecimento da hipertensão portopulmonar em portadores de doenças hepáticas graves, candidatos ao transplante de fígado, assim como das repercussões hemodinâmicas no tratamento cirúrgico desses pacientes, vem ensejando cuidados especiais. A utilização da ecodopplercardiografia, na avaliação pulmonar desses pacientes, tem sido a regra, e aceita como um método acurado [14][15][16] . Entretanto, nos exames ecodopplercardiográficos dos pacientes do presente estudo não foi possível observar alterações significativas que caracterizassem hipertensão pulmonar.…”