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Hepatopulmonary syndromes: treatment of liver transplantation candidates

The hepatopulmonary syndromes are an uncommon and poorly understood complication of chronic liver disease, and they remain a formidable therapeutic challenge for clinicians involved in liver transplantation. The hepatopulmonary syndrome is characterized by hypoxia and intrapulmonary vascular dilatation, whereas portopulmonary hypertension is defined as abnormally high pulmonary artery pressure in the setting of portal hypertension. Once regarded as absolute contraindications to liver transplantation, increasing evidence supports transplantation as a definitive therapy for both these conditions in selected cases. The recognition of adverse prognostic factors in potential transplant candidates is imperative. The institution of novel medical therapies where appropriate, allied with improvement in surgical techniques and refined anesthetic management, have allowed an increasing number of patients with these conditions, traditionally associated with a high mortality, to be successfully transplanted.