Minireviews
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 7, 2013; 19(45): 8252-8257
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8252
Management of portopulmonary hypertension: New perspectives
Luigi Mancuso, Francesca Scordato, Michela Pieri, Eliana Valerio, Andrea Mancuso
Luigi Mancuso, Department of Cardiologia, Ospedale Cervello, 90100 Palermo, Italy
Luigi Mancuso, Francesca Scordato, Michela Pieri, Eliana Valerio, Cardiologia, Clinica Candela, 90100 Palermo, Italy
Andrea Mancuso, Epatologia e Gastroenterologia, Ospedale Niguarda Cà Granda Milano, 20162 Milano, Italy
Andrea Mancuso, Medicina Interna 1, ARNAS Civico, 90100 Palermo, Italy
Author contributions: All the authors gave substantial contributions for conception and design, acquisition of data, or analysis and interpretation of data and drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published.
Correspondence to: Andrea Mancuso, MD, Epatologia e Gastroenterologia, Ospedale Niguarda Cà Granda Milano, Piazza Ospedale Maggiore 3, 20162 Milano, Italy. mancandrea@libero.it
Telephone: +39-3298997893 Fax: +39-91-329447
Received: September 6, 2013
Revised: September 24, 2013
Accepted: October 13, 2013
Published online: December 7, 2013
Processing time: 103 Days and 10.4 Hours
Abstract

Portopulmonary hypertension (PPHTN) is a known complication of cirrhosis. Moderate-to-severe PPHTN implies an extremely poor prognosis. It occurs in 5%-10% of patients referred for liver transplantation (LT), and probably with an higher incidence in patients with large portosystemic shunts. Patients with moderate-to-severe pulmonary hypertension have been previously excluded from LT because of the extremely high surgical risk and since the post-transplant outcome reported was poor. Recently, new perspectives in the management of patients with portopulmonary hypertension are emerging. In fact, some pulmonary vasoactive drugs have become routine in the treatment of patients with idiopathic pulmonary hypertension. These drugs, particularly epoprostenol, have been recently introduced in the treatment of patients with PPHTN, and have been shown to be effective in reducing pulmonary artery pressure as well as pulmonary vascular resistances. Furthermore, recent studies seem to demonstrate that treatment with pulmonary vasoactive drugs could allow liver transplantation with acceptable surgical risks and excellent survival. Although there are not large series nor prospective studies addressing this topic, the clinical scenario of patients with PPHTN seems to be positively changing.

Keywords: Portopulmonary hypertension; Cirrhosis; Liver transplantation; Management; Epoprostenol

Core tip: Moderate-to-severe portopulmonary hypertension (PPHTN) implies an extremely poor prognosis and patients are generally excluded from liver transplantation. Recently, some pulmonary vasoactive drugs have become routine in the treatment of patients with idiopathic pulmonary hypertension and have been recently introduced in the treatment of patients with PPHTN. Recent studies seem to demonstrate that treatment with pulmonary vasoactive drugs could allow liver transplantation with acceptable surgical risks and excellent survival. This paper reports a review on management of PPHTN.