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The clinical significance of intrapulmonary vascular dilations in liver transplant candidates
Author(s) -
Agarwal P. D.,
Hughes P. J.,
Runo J. R.,
Ibrisim D.,
Lucey M. R.,
Said A.
Publication year - 2012
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12033
Subject(s) - hepatopulmonary syndrome , medicine , surgery , cirrhosis , cardiology , portal hypertension
Intrapulmonary vascular dilations ( IPVD ) are common in patients with cirrhosis, but the majority do not have hepatopulmonary syndrome ( HPS ). The clinical significance of IPVD is unknown. Our aim was to determine the clinical impact due to the entire spectrum of IPVD in liver transplant ( LT ) candidates. A total of 122 evaluees for LT underwent contrast transthoracic echocardiography ( cTTE ). The degree of shunting was graded 1–3 (severe). HPS was defined as P a O 2 < 70 mm H g in the presence of IPVD and exclusion of other causes of hypoxemia. IPVD were detected in 57/122 (47%), and of these HPS was found in 5. IPVD were associated with higher Alveolar‐arterial ( A ‐a) gradients, with the highest occurring in patients with HPS ( IPVD vs. no IPVD: p = 0.003; HPS vs. no IPVD : p = 0.004). All patients with HPS had grade 3 shunting, and had significantly widened A ‐a gradient and lower P a O 2 compared with grade 1 or 2 IPVD s. Presence of IPVD did not affect survival measured from evaluation or after LT . Other clinical outcomes were also similar among patients with and without IPVD . IPVD are common among LT candidates. HPS is unlikely in presence of only mild to moderate shunting. Clinical outcomes are similar among patients with and without IPVD .