THE HEPATOPULMONARY SYNDROME

Introduction

The hepatopulmonary syndrome has been acknowledged as an important vascularcomplication in lungs developing systemic hypoxemia in patients with cirrhosis andportal hypertension. Is formed by arterial oxygenation abnormalities induced fromintrapulmonary vascular dilatations with liver disease. It is present in 4-32% ofpatients with cirrhosis. It increases mortality in the setting of cirrhosis andmay influence the frequency and severity. Initially the hypoxemia responds tolow-flow supplemental oxygen, but over time, the need for oxygen supplementationis necessary. The liver transplantation is the only effective therapeutic optionfor its resolution.

Aim

To update clinical manifestation, diagnosis and treatment of this entity.

Method

A literature review was performed on management of hepatopulmonary syndrome. Theelectronic search was held of the Medline-PubMed, in English crossing the headings"hepatopulmonary syndrome", "liver transplantation" and "surgery". The search wascompleted in September 2013.

Results

Hepatopulmonary syndrome is classically defined by a widened alveolar-arterialoxygen gradient (AaPO2) on room air (>15 mmHg, or >20 mmHg in patients>64 years of age) with or without hypoxemia resulting from intrapulmonaryvasodilatation in the presence of hepatic dysfunction or portal hypertension.Clinical manifestation, diagnosis, classification, treatments and outcomes arevaried.

Conclusion

The severity of hepatopulmonary syndrome is an important survival predictor anddetermine the improvement, the time and risks for liver transplantation. The livertransplantation still remains the only effective therapeutic.