Elsevier

Journal of Hepatology

Volume 59, Issue 2, August 2013, Pages 367-374
Journal of Hepatology

Review
Pulmonary contraindications, indications and MELD exceptions for liver transplantation: A contemporary view and look forward

https://doi.org/10.1016/j.jhep.2013.03.026Get rights and content
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open access

Summary

Pulmonary concerns in liver transplant candidates have intraoperative and outcome implications. Evolving MELD exception policies address transplant priority for problems such as hepatopulmonary syndrome, portopulmonary hypertension, and hemorrhagic hereditary telangiectasia. Other pulmonary issues such as refractory hepatic hydrothorax, advanced chronic obstructive lung disease (including alpha-1 antitrypsin deficiency) and indeterminate pulmonary nodules may affect liver transplant consideration. Herein, we discuss current pulmonary-related contraindications, indications and MELD exception policies for liver transplantation, suggesting future considerations.

Abbreviations

LT
liver transplantation
MELD
model for end stage liver disease
HPS
hepatopulmonary syndrome
POPH
portopulmonary hypertension
OPTN
Organ Procurement and Transplant Network
MPAP
mean pulmonary artery pressure
PCWP
pulmonary capillary wedge pressure
PVR
pulmonary vascular resistance
REVEAL
registry to evaluate early and long-term pulmonary artery hypertension
SRTR
scientific registry for transplant recipients
HHT
hereditary hemorrhagic telangiectasia
HVM
hepatic vascular malformations
CO
cardiac output
TPG
transpulmonary gradient
RHH
refractory hepatic hydrothorax
HH
hepatic hydrothorax
TIPS
transjugular intrahepatic portosystemic shunt
COPD
chronic obstructive pulmonary disease
FVC
forced vital capacity
FEV1
forced expiratory volume in one second
AATD
alpha-1 antitrypsin deficiency
HCC
hepatocellular carcinoma
PET
positron emission tomography
FDG
fluorine-18 fluorodeoxyglucose
CT
computed tomography
ILD
interstitial lung disease
IPF
idiopathic pulmonary fibrosis
PBC
primary biliary cirrhosis
TcMAA
technetium macroaggregated albumin
RV
right ventricle

Keywords

Hepatopulmonary syndrome
Portopulmonary hypertension
Hereditary hemorrhagic telangiectasia
Hepatic hydrothorax
Alpha-1 antitrypsin deficiency
Pulmonary nodules

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