Clinical Impact of Intrapulmonary Vascular Dilatation in Candidates for Liver Transplant

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

Research output: Contribution to journalArticle

5 Scopus citations

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)414-426
Number of pages13
JournalChest
Volume153
Issue number2
DOIs
StatePublished - Feb 2018

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

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    DuBrock, H. M., Krowka, M. J., Forde, K. A., Krok, K., Patel, M., Sharkoski, T., Sprys, M., Lin, G., Oh, J. K., Mottram, C. D., Scanlon, P. D., Fallon, M. B., & Kawut, S. M. (2018). Clinical Impact of Intrapulmonary Vascular Dilatation in Candidates for Liver Transplant. Chest, 153(2), 414-426. https://doi.org/10.1016/j.chest.2017.09.035