Hepatopulmonary disorders: Gas exchange and vascular manifestations in chronic liver disease

Robert Rodríguez-Roisin, Michael Joseph Krowka, Alvar Agustí

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

This review concentrates on the determinants of gas exchange abnormalities in liver-induced pulmonary vascular disorders, more specifically in the hepatopulmonary syndrome. Increased alveolar-arterial O2 difference, with or without different levels of arterial hypoxemia, and reduced diffusing capacity represent the most characteristic gas exchange disturbances in the absence of cardiac and pulmonary comorbidities. Pulmonary gas exchange abnormalities in the hepatopulmonary syndrome are unique encompassing all three pulmonary factors determining arterial PO2, that is, ventilation-perfusion imbalance, increased intrapulmonary shunt and oxygen diffusion limitation that, combined, interplay with two relevant nonpulmonary determinants, that is, increased total ventilation and high cardiac output. Behind the complexity of this lung-liver association there is an abnormal pulmonary vascular tone that combines inhibition of hypoxic pulmonary vasoconstriction with a reduced (or blunted) hypoxic vascular response. The pathology and pathobiology include the presence of intrapulmonary vascular dilatations with or without pulmonary vascular remodeling, i.e. angiogenesis. Liver transplantation, the only effective therapeutic approach to successfully improve and resolve the vast majority of complications induced by the hepatopulmonary syndrome, along with a large list of frustrating pharmacologic interventions, are also reviewed. Another liver-induced pulmonary vascular disorder with less gas exchange involvement, such as portopulmonary hypertension, is also considered.

Original languageEnglish (US)
Pages (from-to)711-729
Number of pages19
JournalComprehensive Physiology
Volume8
Issue number2
DOIs
StatePublished - Apr 1 2018

Fingerprint

Blood Vessels
Liver Diseases
Chronic Disease
Gases
Lung
Hepatopulmonary Syndrome
Ventilation
Liver
High Cardiac Output
Pulmonary Gas Exchange
Vasoconstriction
Liver Transplantation
Comorbidity
Dilatation
Perfusion
Pathology
Oxygen
Hypertension

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

Cite this

Hepatopulmonary disorders : Gas exchange and vascular manifestations in chronic liver disease. / Rodríguez-Roisin, Robert; Krowka, Michael Joseph; Agustí, Alvar.

In: Comprehensive Physiology, Vol. 8, No. 2, 01.04.2018, p. 711-729.

Research output: Contribution to journalArticle

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