Successful treatment of severe hepatopulmonary syndrome with a sequential use of TIPS placement and liver transplantation

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dc.contributor.authorBenitez, Carlos
dc.contributor.authorArrese, Marco
dc.contributor.authorJorquera, Jorge
dc.contributor.authorGodoy, Ivan
dc.contributor.authorContreras, Andrea
dc.contributor.authorLoyola, Soledad
dc.contributor.authorPilar Dominguez, P.
dc.contributor.authorJarufe, Nicolas
dc.contributor.authorMartinez, Jorge
dc.contributor.authorPerez-Ayuso, Rosa Maria
dc.date.accessioned2025-01-21T01:04:54Z
dc.date.available2025-01-21T01:04:54Z
dc.date.issued2009
dc.description.abstractHepatopulmonary syndrome (HPS) is a complication of portal hypertension (PH) defined by the presence of liver disease, abnormal pulmonary gas exchange and evidence of intrapulmonary vascular dilatations (IPVD) producing a right to left intrapulmonary shunt. Liver transplantation (LT) is the treatment of choice; however, severe hypoxemia may contraindicate LT. The use of transjugular intrahepatic portosystemic shunts (TIPS) could be effective in HPS, although available data is limited. Aim: To report a clinical case of severe HPS treated sequentially with TIPS and LT. Case report: A 46 year old female cirrhotic patient presented with rapidly progressive dyspnea, hypoxemia (PaO2 60 mmHg, SaO(2) 92%) and increased alveolar-arterial oxygen gradient (A-a) (46 mmHg). She also had orthodeoxia (SaO(2) 87% in sitting position, but 91% in a prone position). A CT scan and pulmonary angiography were normal. Spirometric assessment showed a mild restrictive pattern and a desaturation was observed in a six-minute walking test. Contrast-enhanced echocardiography (CEE) showed intrapulmonary shunting. A HPS was diagnosed and liver transplantation was disregarded due to severe hypoxemia. The patient underwent TIPS placement. After four weeks, a significant improvement of dyspnea and a complete remission of orthodeoxia were seen. One year later, the patient was successfully transplanted. Interestingly, six months after LT, and in the absence of dyspnea, a new CEE showed persistent passing of bubbles to the left cavities. Comments/Conclusion: Persistent right-to-left shunt after TIPS placement and liver transplantation in spite of the improvement of pulmonary function tests suggests long-term persistence of structural changes in the pulmonary vascular tree after liver transplantation. Because of lack of data, it is not possible to recommend the routine use of TIPS as a part of the conventional management of HPS. However, in patients with severe hypoxemia TIPS placement can reasonably be used as a bridge towards transplantation.
dc.fuente.origenWOS
dc.identifier.issn1665-2681
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/95730
dc.identifier.wosidWOS:000263478600015
dc.issue.numero1
dc.language.isoen
dc.pagina.final74
dc.pagina.inicio71
dc.revistaAnnals of hepatology
dc.rightsacceso restringido
dc.subjectCirrhosis
dc.subjectrespiratory failure
dc.subjectliver transplantation
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleSuccessful treatment of severe hepatopulmonary syndrome with a sequential use of TIPS placement and liver transplantation
dc.typeartículo
dc.volumen8
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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