Portopulmonary hypertension: State of the art

Mateo Porres-Aguilar, Marc J. Zuckerman, Juan B. Figueroa-Casas, Michael J. Krowka

Research output: Contribution to journalReview articlepeer-review

48 Scopus citations


Portopulmonary hypertension is an uncommon but treatable pulmonary vascular consequence of portal hypertension, which can lead to significant morbidity and mortality. Portopulmonary hypertension results from excessive pulmonary vasoconstriction and vascular remodeling that eventually leads to right-heart failure and death if left untreated. Although pulmonary vascular disease in these patients may be asymptomatic or associated with subtle and nonspecific symptoms (dyspnea, fatigue and lower extremity swelling), it should be looked for especially if patients are potential candidates for liver transplantation. Patients with clinical suspicion of portopulmonary hypertension should undergo screening testing, specifically echocardiography. Right heart catheterization remains the gold standard for the diagnosis. The existence of moderate to severe disease poses higher risks and challenges for liver transplantation. The disease has a substantial impact on survival and requires focused pharmacological therapy. New and evolving medical therapies, such as prostanoids (intravenous, inhaled or oral), endothelin receptors antagonists, phosphodiesterases inhibitors, combination therapy and other experimental drugs might change the natural course of the disease. Case reports and cases series have been published regarding the efficacy and safety of pharmacological therapy, but randomized, controlled multicenter trials are urgently needed. Liver transplantation is not the treatment of choice for portopulmonary hypertension, but after optimal hemodynamic and clinical improvement with medical therapy as a bridge, liver transplant can be considered an option in selected patients.

Original languageEnglish (US)
Pages (from-to)321-330
Number of pages10
JournalAnnals of hepatology
Issue number4
StatePublished - 2008


  • Liver transplantation
  • Portopulmonary hypertension
  • Pulmonary arterial hypertension
  • Pulmonary hemodynamics
  • Vasodilator therapy

ASJC Scopus subject areas

  • Hepatology


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