Pulmonary Abnormalities in Liver Disease: Relevance to Transplantation and Outcome

Hepatology. 2021 Sep;74(3):1674-1686. doi: 10.1002/hep.31770. Epub 2021 May 24.

Abstract

Pulmonary disease in liver cirrhosis and portal hypertension (PH) constitutes a challenging clinical scenario and may have important implications with regard to prognosis, liver transplantation (LT) candidacy, and post-LT outcome. Pre-LT evaluation should include adequate screening for pulmonary diseases that may occur concomitantly with liver disease as well as for those that may arise as a complication of end-stage liver disease and PH, given that either may jeopardize safe LT and successful outcome. It is key to discriminate those patients who would benefit from LT, especially pulmonary disorders that have been reported to resolve post-LT and are considered "pulmonary indications" for transplant, from those who are at increased mortality risk and in whom LT is contraindicated. In conclusion, in this article, we review the impact of several pulmonary disorders, including cystic fibrosis, alpha 1-antitrypsin deficiency, hereditary hemorrhagic telangiectasia, sarcoidosis, coronavirus disease 2019, asthma, chronic obstructive pulmonary disease, pulmonary nodules, interstitial lung disease, hepatic hydrothorax, hepatopulmonary syndrome, and portopulmonary hypertension, on post-LT survival, as well as the reciprocal impact of LT on the evolution of lung function.

Publication types

  • Review

MeSH terms

  • Adult
  • Asthma / diagnosis
  • Asthma / epidemiology
  • Asthma / mortality
  • COVID-19 / diagnosis
  • COVID-19 / epidemiology
  • COVID-19 / mortality
  • COVID-19 / virology
  • Child
  • Cystic Fibrosis
  • End Stage Liver Disease / complications
  • Hepatopulmonary Syndrome / diagnosis
  • Hepatopulmonary Syndrome / epidemiology
  • Hepatopulmonary Syndrome / mortality
  • Humans
  • Hypertension, Portal / complications*
  • Hypertension, Pulmonary / drug therapy
  • Hypertension, Pulmonary / etiology
  • Liver Cirrhosis / complications*
  • Liver Transplantation / methods
  • Liver Transplantation / mortality*
  • Lung Diseases / complications*
  • Lung Diseases / epidemiology
  • Lung Diseases / pathology
  • Lung Diseases / physiopathology
  • Mass Screening
  • Patient Selection / ethics
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Respiratory Function Tests / methods
  • SARS-CoV-2 / genetics
  • SARS-CoV-2 / isolation & purification
  • Sarcoidosis / diagnosis
  • Sarcoidosis / epidemiology
  • Sarcoidosis / mortality
  • Survival Rate / trends
  • Telangiectasia, Hereditary Hemorrhagic / diagnosis
  • Telangiectasia, Hereditary Hemorrhagic / epidemiology
  • Telangiectasia, Hereditary Hemorrhagic / mortality
  • alpha 1-Antitrypsin Deficiency / diagnosis
  • alpha 1-Antitrypsin Deficiency / epidemiology
  • alpha 1-Antitrypsin Deficiency / mortality