Current concepts in the treatment of hepatopulmonary syndrome

Abstract

The aim of the present review is to cover various aspects of treatment of pulmonary dysfunctions in patients with hepatopulmonary syndrome (HPS), which represents important complication to cirrhosis and portal hypertension. For the articles and reviews about pulmonary dysfunction and it treatment in HPS was searched HINARI and MedLINE. The keywords were: pulmonary dysfunction in HPS, treatment of HPS. Multiple medical therapies have been investigated for the treatment of HPS in small studies but with low answer to medical therapy. An investigation into the efficacy of pentoxifylline, a nonspecific phosphodiesterase inhibitor that is recognized to block effects mediated by TNF-a in inflammatory and endothelial cells, has been shown improvement of intrapulmonary vasodilatation and gas exchange abnormalities. Other studies have looked at the contribution of somatostatin analogs, amiltrine, indomethacin and blockers of AT-II like losartan show benefits in arterial oxygenation. Liver transplantation is considered to be the definitive treatment of HPS with often successful reversal of hypoxemia; however other treatments have been trialed about mediators (nitric oxide) disorder in lung vessels and block synthesis of vasodilatationvasoconstrictive substances at liver level. Currently, no effective medical therapies for the hepatopulmonary syndrome exist, and liver transplantation is the only successful treatment. It is necessary to study efficiency of the new drugs in lung vascular disorders in liver cirrhosis.