Liver transplantation is potentially a life-saving therapeutic intervention for patients with portopulmonary hypertension and hepatopulmonary syndrome.
However, due to limited data, listing criteria for patients with these conditions have not been clearly established.
Indeed, this has led some to speculate that transplantation may not be appropriate in cases of moderate-to-severe portopulmonary hypertension and severe hepatopulmonary syndrome.
Dr Houlihan and colleagues from the United Kingdom critically discussed the utility of liver transplantation for the treatment of hepatopulmonary syndrome and portopulmonary hypertension.
The research team conducted a literature search in 2012 on PubMed, Ovid Embase, Ovid Medline and Scopus for terms including hepatopulmonary syndrome, portopulmonary hypertension, pulmonary arterial hypertension, liver transplantation.
Relevant manuscripts were included in the review.
|Careful patient selection is successfully being used to treat portopulmonary hypertension|
|Alimentary Pharmacology & Therapeutics|
The researchers report that liver transplantation has established itself as an effective treatment for selected patients with hepatopulmonary syndrome and portopulmonary hypertension.
A multidisciplinary team approach incorporating focused strategies aimed at improving oxygenation in patients with hepatopulmonary syndrome has led to a dramatic improvement in patient outcomes.
In addition, the team noted that careful patient selection, and the use of targeted pulmonary vascular therapies are successfully being used to treat portopulmonary hypertension, and ‘bridge’ patients to successful liver transplantation.
Dr Houlihan's team concluded, "Liver transplantation is an effective therapy for patients with hepatopulmonary syndrome and portopulmonary hypertension."
"However, rigorous screening and early identification of these conditions allied with aggressive pre-operative optimisation of physiology and diligent post-operative care are imperative to ensuring a good outcome."