Pulmonary complications in chronic liver disease

Authors

  • Victor I. Machicao,

    1. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX
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  • Maya Balakrishnan,

    1. Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
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  • Michael B. Fallon

    Corresponding author
    1. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX
    • Address reprint requests to: Michael B. Fallon, M.D., 6431 Fannin St., MSB 4.234, Houston, TX 77030-1501. E-mail: Michael.b.fallon@uth.tmc.edu; fax: 713-500-6699.

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  • Potential conflict of interest: Nothing to report.

  • Supported by 5DKR01DK056804 to M.B.F. The funding source had no role in preparation of the article.

Abstract

The association of chronic liver disease with respiratory symptoms and hypoxia is well recognized. Over the last century, three pulmonary complications specific to chronic liver disease have been characterized: hepatopulmonary syndrome (HPS), portopulmonary hypertension (POPH), and hepatic hydrothorax (HH). The development of portal hypertension is fundamental in the pathogenesis of each of these disorders. HPS is the most common condition, found in 5%-30% of cirrhosis patients, manifested by abnormal oxygenation due to the development of intrapulmonary vascular dilatations. The presence of HPS increases mortality and impairs quality of life, but is reversible with liver transplantation (LT). POPH is characterized by development of pulmonary arterial hypertension in the setting of portal hypertension, and is present in 5%-10% of cirrhosis patients evaluated for LT. Screening for POPH in cirrhosis patients eligible for LT is critical since severe POPH is a relative contraindication for LT. Patients with moderate POPH, who respond adequately to medical therapy, may benefit from LT, although sufficient controlled data are lacking. HH is a transudative pleural effusion seen in 5%-10% of cirrhosis patients, in the absence of cardiopulmonary disease. Diagnosis of HH should prompt consideration for LT, which is the ultimate treatment for HH. Conservative management includes salt restriction and diuretics, with thoracentesis and transjugular intrahepatic portosystemic shunt (TIPS) as second-line therapeutic options. (Hepatology 2014;59:1627-1637)

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