Hepatopulmonary Syndrome

Occurs in up to 10–32% of pts with cirrhosis.

Dyspnea is present in up to 70% of cirrhotic pts for varying reasons (ascites, ILD, volume overload, anemia).

Hypoxemia, often worsened on induction and post LT

Aspiration

Hemodynamic instability and CV collapse

Acute/chronic renal insufficiency

Myocardial infarction

Full stomach and aspiration risk in presence of ascites and increased intraabdominal pressures

Hypoxemia (exacerbated in immediate post LT period)

Severe post LT hypoxemia and possible RV failure related to pulm vasoconstriction from an abrupt change in vascular mediators from the new liver

Hemodynamic instability, especially related to reperfusion during LT

Pulm complication of cirrhosis resulting in arterial hypoxemia.

Defined as triad of liver disease, intravascular pulm vasodilatation, and abnormal gas exchange.

Cirrhosis pts with hepatopulmonary syndrome have a higher mortality than those without it.

Liver transplant is the only definitive treatment.