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

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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)