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World J Gastroenterol. Jul 14, 2016; 22(26): 6008-6015
Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.6008
Pulmonary complications of hepatic diseases
Salim R Surani, Yamely Mendez, Humayun Anjum, Joseph Varon
Salim R Surani, University of North Texas, Aransas Pass, TX 78366, United States
Yamely Mendez, Dorrington Medical Associates, PA and Facultad de Medicina, Universidad Autónoma de Tamaulipas, Houston, TX 77030, United States
Humayun Anjum, Faculty, Bay Area Medical Center, Corpus Christi, TX 78412, United States
Joseph Varon, Clinical Medicine, The University of Texas Medical Branch at Galveston, Houston, TX 77030, United States
Author contributions: All of the authors have been involved in writing, editing, review and revision of the manuscript.
Conflict-of-interest statement: None of the authors have any conflict to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salim R Surani, MD, University of North Texas, 1177 West Wheeler Ave, Aransas Pass, TX 78366, United States. srsurani@hotmail.com
Telephone: +1-361-8857722 Fax: +1-361-8507563
Received: March 20, 2016
Peer-review started: March 22, 2016
First decision: April 14, 2016
Revised: May 1, 2016
Accepted: May 21, 2016
Article in press: May 23, 2016
Published online: July 14, 2016
Abstract

Severe chronic liver disease (CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary pathology that they may have. Among them the hepatopulmonary syndrome (HPS), portopulmonary hypertension (PPH) and hepatic hydrothorax (HH) are described in detail in this literature review. HPS is encountered in approximately 15% to 30% of the patients and its presence is associated with increase in mortality and also requires liver transplantation in many cases. PPH has been reported among 4%-8% of the patient with CLD who have undergone liver transplantation. The HH is another entity, which has the prevalence rate of 5% to 6% and is associated in the absence of cardiopulmonary disease. These clinical syndromes occur in similar pathophysiologic environments. Most treatment modalities work as temporizing measures. The ultimate treatment of choice is liver transplant. This clinical review provides basic concepts; pathophysiology and clinical presentation that will allow the clinician to better understand these potentially life-threatening complications. This article will review up-to-date information on the pathophysiology, clinical features and the treatment of the pulmonary complications among liver disease patients.

Keywords: Portopulmonary hypertension, Hepatopulmonary syndrome, Cirrhosis, Hepatocellular failure, Hepatic hydrothorax, Intrapulmonary shunting

Core tip: Pulmonary complications are found in some patients with liver disease. The hepatopulmonary syndrome is found in 15% to 30% and, its presence, increases mortality and risk of requiring liver transplantation. Portopulmonary hypertension has been reported to be present in 4% to 8% in patients whom have undergone liver transplant evaluation. Hepatic hydrothorax, with a prevalence of 5%-6% in these patients, is suspected when a patient develops pleural effusions without presence of cardiopulmonary disease. All of these entities can only be solved with successful liver transplant.