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Recent advances in the approach to hepatopulmonary syndrome and portopulmonary hypertension

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Abstract
Liver disease, cirrhosis and portal hypertension can be complicated by pulmonary vascular disease, which may affect prognosis and influence liver transplantation (LT) candidacy. Pulmonary vascular complications comprise hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH). Although these two conditions develop on a same background and share a common trigger, pulmonary responses are distinct and occur at different anatomical sites of the pulmonary circulation. HPS affects 10-30% of patients referred for LT, and is characterized by gas exchange abnormalities due to pulmonary vasodilation and right-to-left shunting. POPH occurs in 5%, and is defined by pulmonary arterial hypertension due to increased pulmonary vascular resistance, which leads to hemodynamic failure. Even though HPS and POPH may have a substantial negative impact on survival, both entities are clinically underrecognized and frequently misdiagnosed. Without intervention, the 5-year survival rate is 23% in HPS and 14% in POPH. Their presence should be actively sought by organized screening in patients presenting with dyspnea and in all patients on the waitlist for LT, also because clinical symptoms are commonly non-specific or even absent. LT may lead to resolution, however, advanced stages of either HPS or POPH may jeopardize safe and successful LT. This implicates the need of proper identification of HPS and POPH cases, as well as the need to be able to successfully 'bridge' patients to LT by medical intervention. A review article on this topic has been published in this journal in 2007 (1). This updated review focuses on recent advances in the diagnosis and management of these 2 liver-induced pulmonary vascular disorders and incorporates results from our recent work.
Keywords
liver disease, cirrhosis, portal hypertension, pulmonary vascular complications, LIVER-TRANSPLANTATION, CIRRHOTIC-PATIENTS, SURVIVAL, IMPACT, CANDIDATES, DIAGNOSIS, OUTCOMES, POLICY

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MLA
Raevens, Sarah, et al. “Recent Advances in the Approach to Hepatopulmonary Syndrome and Portopulmonary Hypertension.” ACTA GASTRO-ENTEROLOGICA BELGICA, vol. 84, no. 1, 2021, pp. 95–99, doi:10.51821/84.1.200.
APA
Raevens, S., Geerts, A., Devisscher, L., Van Vlierberghe, H., Van Steenkiste, C., & Colle, I. (2021). Recent advances in the approach to hepatopulmonary syndrome and portopulmonary hypertension. ACTA GASTRO-ENTEROLOGICA BELGICA, 84(1), 95–99. https://doi.org/10.51821/84.1.200
Chicago author-date
Raevens, Sarah, Albert Geerts, Lindsey Devisscher, Hans Van Vlierberghe, Christophe Van Steenkiste, and Isabelle Colle. 2021. “Recent Advances in the Approach to Hepatopulmonary Syndrome and Portopulmonary Hypertension.” ACTA GASTRO-ENTEROLOGICA BELGICA 84 (1): 95–99. https://doi.org/10.51821/84.1.200.
Chicago author-date (all authors)
Raevens, Sarah, Albert Geerts, Lindsey Devisscher, Hans Van Vlierberghe, Christophe Van Steenkiste, and Isabelle Colle. 2021. “Recent Advances in the Approach to Hepatopulmonary Syndrome and Portopulmonary Hypertension.” ACTA GASTRO-ENTEROLOGICA BELGICA 84 (1): 95–99. doi:10.51821/84.1.200.
Vancouver
1.
Raevens S, Geerts A, Devisscher L, Van Vlierberghe H, Van Steenkiste C, Colle I. Recent advances in the approach to hepatopulmonary syndrome and portopulmonary hypertension. ACTA GASTRO-ENTEROLOGICA BELGICA. 2021;84(1):95–9.
IEEE
[1]
S. Raevens, A. Geerts, L. Devisscher, H. Van Vlierberghe, C. Van Steenkiste, and I. Colle, “Recent advances in the approach to hepatopulmonary syndrome and portopulmonary hypertension,” ACTA GASTRO-ENTEROLOGICA BELGICA, vol. 84, no. 1, pp. 95–99, 2021.
@article{8731432,
  abstract     = {{Liver disease, cirrhosis and portal hypertension can be complicated by pulmonary vascular disease, which may affect prognosis and influence liver transplantation (LT) candidacy. Pulmonary vascular complications comprise hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH). Although these two conditions develop on a same background and share a common trigger, pulmonary responses are distinct and occur at different anatomical sites of the pulmonary circulation. HPS affects 10-30% of patients referred for LT, and is characterized by gas exchange abnormalities due to pulmonary vasodilation and right-to-left shunting. POPH occurs in 5%, and is defined by pulmonary arterial hypertension due to increased pulmonary vascular resistance, which leads to hemodynamic failure. Even though HPS and POPH may have a substantial negative impact on survival, both entities are clinically underrecognized and frequently misdiagnosed. Without intervention, the 5-year survival rate is 23% in HPS and 14% in POPH. Their presence should be actively sought by organized screening in patients presenting with dyspnea and in all patients on the waitlist for LT, also because clinical symptoms are commonly non-specific or even absent. LT may lead to resolution, however, advanced stages of either HPS or POPH may jeopardize safe and successful LT. This implicates the need of proper identification of HPS and POPH cases, as well as the need to be able to successfully 'bridge' patients to LT by medical intervention. A review article on this topic has been published in this journal in 2007 (1). This updated review focuses on recent advances in the diagnosis and management of these 2 liver-induced pulmonary vascular disorders and incorporates results from our recent work.}},
  author       = {{Raevens, Sarah and Geerts, Albert and Devisscher, Lindsey and Van Vlierberghe, Hans and Van Steenkiste, Christophe and Colle, Isabelle}},
  issn         = {{1784-3227}},
  journal      = {{ACTA GASTRO-ENTEROLOGICA BELGICA}},
  keywords     = {{liver disease,cirrhosis,portal hypertension,pulmonary vascular complications,LIVER-TRANSPLANTATION,CIRRHOTIC-PATIENTS,SURVIVAL,IMPACT,CANDIDATES,DIAGNOSIS,OUTCOMES,POLICY}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{95--99}},
  title        = {{Recent advances in the approach to hepatopulmonary syndrome and portopulmonary hypertension}},
  url          = {{http://doi.org/10.51821/84.1.200}},
  volume       = {{84}},
  year         = {{2021}},
}

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