Clinical Impact of Intrapulmonary Vascular Dilatation in Candidates for Liver Transplant

Hilary M. DuBrock, Michael Joseph Krowka, Kimberly A. Forde, Karen Krok, Mamta Patel, Tiffany Sharkoski, Michael Sprys, Grace D Lin, Jae Kuen Oh, Carl D. Mottram, Paul D Scanlon, Michael B. Fallon, Steven M. Kawut

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Intrapulmonary vascular dilatations (IPVD) frequently are detected in patients with liver disease by the delayed appearance of microbubbles at contrast-enhanced echocardiography. IPVD with an elevated alveolar-arterial (A-a) gradient define hepatopulmonary syndrome (HPS); however, the importance of IPVD in the absence of abnormal gas exchange is unknown. We aimed to determine the clinical impact of IPVD in patients with liver disease. Methods: We performed a cross-sectional study within the Pulmonary Vascular Complications of Liver Disease 2 Study, a multicenter, prospective cohort study of patients being evaluated for liver transplant. We excluded patients with obstructive or restrictive lung disease, HPS, or intracardiac shunting. We compared patients with and those without IPVD. Results: Forty-six patients with IPVD and 81 patients without IPVD were included. Patients with IPVD were more likely to have autoimmune hepatitis and less likely to have cryptogenic cirrhosis and hepatocellular carcinoma. Patients with IPVD had higher Child-Pugh scores (6 [interquartile range (IQR), 5-7] vs 5 [IQR, 4-7]; P =.04), possibly higher Model for End-Stage Liver Disease scores (14.5 [IQR, 11.6-15.8] vs 12.2 [IQR, 9.4-15.5]; P =.06), higher PaO2 levels (97.9 [IQR, 92.0-103.0] vs 89.0 [IQR, 82.0-96.9] mm Hg; P <.001), and lower A-a gradients (9.9 [IQR, 6.2-13.5] vs 14.9 [IQR, 9.0-21.8] mm Hg; P <.001). Symptoms and quality of life were similar between the groups. Conclusions: Autoimmune hepatitis and increased liver disease severity were associated with the presence of IPVD, which was characterized by higher PaO2 levels. Future studies to better characterize IPVD pathogenesis and the relationship of IPVD to HPS are warranted.

Original languageEnglish (US)
Pages (from-to)339-348
Number of pages10
JournalChest
Volume153
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Blood Vessels
Dilatation
Transplants
Liver
Hepatopulmonary Syndrome
Liver Diseases
Autoimmune Hepatitis
Microbubbles
End Stage Liver Disease
Lung Diseases
Multicenter Studies
Echocardiography
Hepatocellular Carcinoma
Cohort Studies
Cross-Sectional Studies
Gases
Quality of Life
Prospective Studies
Lung

Keywords

  • hepatopulmonary syndrome
  • intrapulmonary vascular dilatation
  • liver transplant

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

DuBrock, H. M., Krowka, M. J., Forde, K. A., Krok, K., Patel, M., Sharkoski, T., ... Kawut, S. M. (2018). Clinical Impact of Intrapulmonary Vascular Dilatation in Candidates for Liver Transplant. Chest, 153(2), 339-348. https://doi.org/10.1016/j.chest.2017.09.035

Clinical Impact of Intrapulmonary Vascular Dilatation in Candidates for Liver Transplant. / DuBrock, Hilary M.; Krowka, Michael Joseph; Forde, Kimberly A.; Krok, Karen; Patel, Mamta; Sharkoski, Tiffany; Sprys, Michael; Lin, Grace D; Oh, Jae Kuen; Mottram, Carl D.; Scanlon, Paul D; Fallon, Michael B.; Kawut, Steven M.

In: Chest, Vol. 153, No. 2, 01.02.2018, p. 339-348.

Research output: Contribution to journalArticle

DuBrock, HM, Krowka, MJ, Forde, KA, Krok, K, Patel, M, Sharkoski, T, Sprys, M, Lin, GD, Oh, JK, Mottram, CD, Scanlon, PD, Fallon, MB & Kawut, SM 2018, 'Clinical Impact of Intrapulmonary Vascular Dilatation in Candidates for Liver Transplant', Chest, vol. 153, no. 2, pp. 339-348. https://doi.org/10.1016/j.chest.2017.09.035
DuBrock, Hilary M. ; Krowka, Michael Joseph ; Forde, Kimberly A. ; Krok, Karen ; Patel, Mamta ; Sharkoski, Tiffany ; Sprys, Michael ; Lin, Grace D ; Oh, Jae Kuen ; Mottram, Carl D. ; Scanlon, Paul D ; Fallon, Michael B. ; Kawut, Steven M. / Clinical Impact of Intrapulmonary Vascular Dilatation in Candidates for Liver Transplant. In: Chest. 2018 ; Vol. 153, No. 2. pp. 339-348.
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abstract = "Background: Intrapulmonary vascular dilatations (IPVD) frequently are detected in patients with liver disease by the delayed appearance of microbubbles at contrast-enhanced echocardiography. IPVD with an elevated alveolar-arterial (A-a) gradient define hepatopulmonary syndrome (HPS); however, the importance of IPVD in the absence of abnormal gas exchange is unknown. We aimed to determine the clinical impact of IPVD in patients with liver disease. Methods: We performed a cross-sectional study within the Pulmonary Vascular Complications of Liver Disease 2 Study, a multicenter, prospective cohort study of patients being evaluated for liver transplant. We excluded patients with obstructive or restrictive lung disease, HPS, or intracardiac shunting. We compared patients with and those without IPVD. Results: Forty-six patients with IPVD and 81 patients without IPVD were included. Patients with IPVD were more likely to have autoimmune hepatitis and less likely to have cryptogenic cirrhosis and hepatocellular carcinoma. Patients with IPVD had higher Child-Pugh scores (6 [interquartile range (IQR), 5-7] vs 5 [IQR, 4-7]; P =.04), possibly higher Model for End-Stage Liver Disease scores (14.5 [IQR, 11.6-15.8] vs 12.2 [IQR, 9.4-15.5]; P =.06), higher PaO2 levels (97.9 [IQR, 92.0-103.0] vs 89.0 [IQR, 82.0-96.9] mm Hg; P <.001), and lower A-a gradients (9.9 [IQR, 6.2-13.5] vs 14.9 [IQR, 9.0-21.8] mm Hg; P <.001). Symptoms and quality of life were similar between the groups. Conclusions: Autoimmune hepatitis and increased liver disease severity were associated with the presence of IPVD, which was characterized by higher PaO2 levels. Future studies to better characterize IPVD pathogenesis and the relationship of IPVD to HPS are warranted.",
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AU - Forde, Kimberly A.

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AU - Patel, Mamta

AU - Sharkoski, Tiffany

AU - Sprys, Michael

AU - Lin, Grace D

AU - Oh, Jae Kuen

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N2 - Background: Intrapulmonary vascular dilatations (IPVD) frequently are detected in patients with liver disease by the delayed appearance of microbubbles at contrast-enhanced echocardiography. IPVD with an elevated alveolar-arterial (A-a) gradient define hepatopulmonary syndrome (HPS); however, the importance of IPVD in the absence of abnormal gas exchange is unknown. We aimed to determine the clinical impact of IPVD in patients with liver disease. Methods: We performed a cross-sectional study within the Pulmonary Vascular Complications of Liver Disease 2 Study, a multicenter, prospective cohort study of patients being evaluated for liver transplant. We excluded patients with obstructive or restrictive lung disease, HPS, or intracardiac shunting. We compared patients with and those without IPVD. Results: Forty-six patients with IPVD and 81 patients without IPVD were included. Patients with IPVD were more likely to have autoimmune hepatitis and less likely to have cryptogenic cirrhosis and hepatocellular carcinoma. Patients with IPVD had higher Child-Pugh scores (6 [interquartile range (IQR), 5-7] vs 5 [IQR, 4-7]; P =.04), possibly higher Model for End-Stage Liver Disease scores (14.5 [IQR, 11.6-15.8] vs 12.2 [IQR, 9.4-15.5]; P =.06), higher PaO2 levels (97.9 [IQR, 92.0-103.0] vs 89.0 [IQR, 82.0-96.9] mm Hg; P <.001), and lower A-a gradients (9.9 [IQR, 6.2-13.5] vs 14.9 [IQR, 9.0-21.8] mm Hg; P <.001). Symptoms and quality of life were similar between the groups. Conclusions: Autoimmune hepatitis and increased liver disease severity were associated with the presence of IPVD, which was characterized by higher PaO2 levels. Future studies to better characterize IPVD pathogenesis and the relationship of IPVD to HPS are warranted.

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