Hepatopulmonary syndrome:

Is it time to redefine the MELD exception score for better organ allocation and outcomes? 

Autores: Gallegos Orozco Juan Fernando, Porres Aguilar Mateo


Article commented Goldberg DS, Krok K, Batra S, Trotter JF, Kawut SM, Fallon MB. Impact of the hepatopulmonary syndrome MELD exception policy on outcomes of patients after liver transplantation: An analysis of the UNOS database. Gastroenterology 2014; 146: 1256-65. Comment Hepatopulmonary syndrome (HPS) represents a serious lung vascular disorder, resulting in significant morbidity and mortality, especially when liver transplantation (LT) is being considered, influencing the pre, trans, and post-LT outcomes. HPS is best characterized by the documentation of impaired oxygenation (widened alveolar-arterial oxygen pressure gradient [PA-aO2] > 15 or > 20 mmHg in patients older than 64 years, with or without concomitant hypoxemia at room air) in the setting of intrapulmonary vascular dilatations (IPVD) confirmed by contrast-enhanced echocardiography or lung perfusion scanning (shunt fraction > 6%) and liver disease or portal hypertension. HPS can occur in the setting of any degree of liver disease, from well-compensated liver cirrhosis with portal hypertension to acute liver failure. The prevalence of HPS ranges from 1-4% in non-LT referral community hospitals up to 32% in patients being evaluated for LT. Perhaps such a differing prevalence can be attributed to the wide heterogeneity of the applied diagnostic criteria.

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2014-07-07   |   375 visitas   |   Evalua este artículo 0 valoraciones

Vol. 13 Núm.4. Julio-Agosto 2014 Pags. 468-470 Ann Hepatol 2014; 13(4)