411
Views
5
CrossRef citations to date
0
Altmetric
Review

Pathophysiological-based treatments of complications of cirrhosis

, , &
Pages 383-394 | Received 14 Jan 2020, Accepted 13 Mar 2020, Published online: 01 Apr 2020

References

  • Mokdad AA, Lopez AD, Shahraz S, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med. 2014;12(1):145.
  • Blachier M, Leleu H, Peck-Radosavljevic M, et al. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58(3):593–608.
  • Jepsen P, Lash TL, Vilstrup H. The clinical course of alcoholic cirrhosis: development of comorbid diseases. A Danish nationwide cohort study. Liver Int. 2016;36(11):1696–1703.
  • Allen AM, Kim WR, Moriarty JP, et al. Time trends in the Hhalthcare burden and mortality of acute on chronic liver failure (ACLF) in the United States. Hepatology. 2016;64(6):2165–2172.
  • Tandon P, Garcia-Tsao G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis. 2008;28(1):026–042.
  • Møller S, Bendtsen F. Cirrhotic multiorgan syndrome. Dig Dis Sci. 2015;60(11):3209–3225.
  • Das UN. Beneficial role of bioactive lipids in the pathobiology, prevention, and management of HBV, HCV and alcoholic hepatitis, NAFLD, and liver cirrhosis: a review. J Adv Res. 2019;17:17–29.
  • Pimpin L, Cortez-Pinto H, Negro F, et al. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2018;69(3):718–735.
  • Levy S, Samuel D. Prevention of decompensation in cirrhosis: a new youth for beta blockers. Lancet. 2019;393(10181):1571–1572.
  • Vilaseca M, Guixe-Muntet S, Fernandez-Iglesias A, et al. Advances in therapeutic options for portal hypertension. Therap Adv Gastroenterol. 2018;11:175628481881129.
  • Becker U, Deis A, Sorensen TIA, et al. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study. Hepatology. 1996;23(5):1025–1029.
  • Dam MK, Flensborg-Madsen T, Eliasen M, et al. Smoking and risk of liver cirrhosis: a population-based cohort study. Scand J Gastroenterol. 2013;48(5):585–591.
  • Dam-Larsen S, Franzmann MB, Christoffersen P, et al. Histological characteristics and prognosis in patients with fatty liver. Scand J Gastroenterol. 2005;40(4):460–467.
  • Stickel F, Datz C, Hampe J, et al. Pathophysiology and management of alcoholic liver disease: update 2016. Gut Liver. 2017;11(2):173–188.
  • Laursen TL, Hagemann CA, Wei C, et al. Bariatric surgery in patients with non-alcoholic fatty liver disease – from pathophysiology to clinical effects. WJH. 2019;11(2):138–149.
  • Friedman SL, Neuschwander-Tetri BA, Rinella M, et al. Mechanisms of NAFLD development and therapeutic strategies. Nat Med. 2018;24(7):908–922.
  • Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015;62(1):S47–S64.
  • Traussnigg S, Kienbacher C, Halilbasic E, et al. Challenges and management of liver cirrhosis: practical issues in the therapy of patients with cirrhosis due to NAFLD and NASH. Dig Dis. 2015;33(4):598–607.
  • Jahn D, Rau M, Wohlfahrt J, et al. Non-alcoholic steatohepatitis: from pathophysiology to novel therapies. Dig Dis. 2016;34(4):356–363.
  • Adams LA. End-points for drug treatment in NASH. Hepatol Int. 2019;13(3):253–258.
  • Iwakiri Y, Shah V, Rockey DC. Vascular pathobiology in chronic liver disease and cirrhosis – current status and future directions. J Hepatol. 2014;61(4):912–924.
  • Greuter T, Shah VH. Hepatic sinusoids in liver injury, inflammation, and fibrosis: new pathophysiological insights. J Gastroenterol. 2016;51(6):511–519.
  • Ames PR, Guardascione M, Batuca JR, et al. Nitric oxide metabolites, nitrative stress, and paraoxonase activity in hepatopulmonary syndrome. Scand J Gastroenterol. 2016;51(1):73–77.
  • Abraldes JG, Iwakiri Y, Loureiro-Silva M, et al. Mild increases in portal pressure upregulate vascular endothelial growth factor and endothelial nitric oxide synthase in the intestinal microcirculatory bed, leading to a hyperdynamic state. Am J Physiol Gastrointest Liver Physiol. 2006;290(5):G980–G987.
  • Friedman SL. Hepatic stellate cells: protean, multifunctional, and enigmatic cells of the liver. Physiol Rev. 2008;88(1):125–172.
  • Lee UE, Friedman SL. Mechanisms of hepatic fibrogenesis. Best Pract Res Clin Gastroenterol. 2011;25(2):195–206.
  • Friedman SL, Sheppard D, Duffield JS, et al. Therapy for fibrotic diseases: nearing the starting line. Sci Transl Med. 2013;5(167):167sr1–167sr1.
  • Schuppan D, Surabattula R, Wang XY. Determinants of fibrosis progression and regression in NASH. J Hepatol. 2018;68(2):238–250.
  • Rockey DC. Hepatic fibrosis, stellate cells, and portal hypertension. Clin Liver Dis. 2006;10(3):459–479.
  • Puche JE, Saiman Y, Friedman SL. Hepatic stellate cells and liver fibrosis. Compr Physiol. 2013;3(4):1473–1492.
  • DeLeve LD. Liver sinusoidal endothelial cells and liver regeneration. J Clin Invest. 2013;123(5):1861–1866.
  • Gracia-Sancho J, Marrone G, Fernández-Iglesias A. Hepatic microcirculation and mechanisms of portal hypertension. Nat Rev Gastroenterol Hepatol. 2019;16(4):221–234.
  • Hammoutene A, Rautou PE. Role of liver sinusoidal endothelial cells in non-alcoholic fatty liver disease. J Hepatol. 2019;70(6):1278–1291.
  • Braet F, Wisse E. Structural and functional aspects of liver sinusoidal endothelial cell fenestrae: a review. Comp Hepatol. 2002;1(1):1.
  • Iwakiri Y, Kim MY. Nitric oxide in liver diseases. Trends Pharmacol Sci. 2015;36(8):524–536.
  • Banales JM, Marzioni M, Larusso NF, et al. Cholangiocytes in health and disease: from basic science to novel treatments. Biochim Biophys Acta Mol Basis Dis. 2018;1864(4):1217–1219.
  • Luo B, Tang L, Wang Z, et al. Cholangiocyte endothelin 1 and transforming growth factor beta1 production in rat experimental hepatopulmonary syndrome. Gastroenterology. 2005;129(2):682–695.
  • Lukacs-Kornek V, Lammert F. The progenitor cell dilemma: cellular and functional heterogeneity in assistance or escalation of liver injury. J Hepatol. 2017;66(3):619–630.
  • Lleo A, Maroni L, Glaser S, et al. Role of cholangiocytes in primary biliary cirrhosis. Semin Liver Dis. 2014;34(03):273–284.
  • Bosch J, Groszmann RJ, Shah VH. Evolution in the understanding of the pathophysiological basis of portal hypertension: how changes in paradigm are leading to successful new treatments. J Hepatol. 2015;62(1):S121–S130.
  • Pinzani M. Pathophysiology of liver fibrosis. Dig Dis. 2015;33(4):492–497.
  • Berzigotti A, De Gottardi A, Vukotic R, et al. Effect of meal ingestion on liver stiffness in patients with cirrhosis and portal hypertension. PLoS One. 2013;8(3):e58742.
  • Iwakiri Y. The molecules: mechanisms of arterial vasodilatation observed in the splanchnic and systemic circulation in portal hypertension. J Clin Gastroenterol. 2007;41(Supplement 3):S288–S294.
  • Bolognesi M, Di Pascoli M, Verardo A, et al. Splanchnic vasodilation and hyperdynamic circulatory syndrome in cirrhosis. WJG. 2014;20(10):2555–2563.
  • Wiese S, Bendtsen F, Møller S. Cardiac biomarkers in cirrhotis and portal hypertension: relation to circulatory and cardiac dysfunction. In: Patel VB, Preedy VR, editors. Biomarkers in cardiovascular disease. 1st ed. Dordrecht: Springer; 2016. p. 573–599.
  • Wiese S, Mortensen C, Gotze JP, et al. Cardiac and proinflammatory markers predict prognosis in cirrhosis. Liver Int. 2014;34(6):e19–e30.
  • Kimer N, Goetze JP, Bendtsen F, et al. New vasoactive peptides in cirrhosis: organ extraction and relation to the vasodilatory state. Eur J Clin Invest. 2014;44(5):441–452.
  • Di PM, Sacerdoti D, Pontisso P, et al. Molecular mechanisms leading to splanchnic vasodilation in liver cirrhosis. J Vasc Res. 2017;54(2):92–99.
  • Hobolth L, Bendtsen F, Møller S. Indications for portal pressure measurement in chronic liver disease. Scand J Gastroenterol. 2012;47(8-9):887–892.
  • de Franchis R. Expanding censensus in portal hypertension. Report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743–752.
  • Thabut D, Bureau C, Layese R, et al. Validation of Baveno VI criteria for screening and surveillance of esophageal varices in patients with compensated cirrhosis and a sustained response to antiviral therapy. Gastroenterology. 2019;156(4):997–1009.e5.
  • de Franchis R, Dell’era A. Invasive and noninvasive methods to diagnose portal hypertension and esophageal varices. Clin Liver Dis. 2014;18(2):293–302.
  • Bendtsen F, Krag A, Møller S. Treatment of acute variceal bleeding. Dig Liver Dis. 2008;40(5):328–336.
  • D’amico G, Morabito A, D’Amico M, et al. Clinical states of cirrhosis and competing risks. J Hepatol. 2018;68(3):563–576.
  • Turco L, Villanueva C, La M,V, et al. Lowering portal pressure improves outcomes of patients with cirrhosis, with or without ascites: a meta-analysis. Clin Gastroenterol Hepatol. 2019;18(2):313–327.e6.
  • La MV, Abraldes JG, Raffa S, et al. Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension. J Hepatol. 2009;51(2):274–287.
  • Villanueva C, Aracil C, Colomo A, et al. Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding. Gastroenterology. 2009;137(1):119–128.
  • D’amico G, Malizia G, Bosch J. Beta-blockers in 2016: still the safest and most useful drugs for portal hypertension? Hepatology. 2016;63(6):1771–1773.
  • Villanueva C, Albillos A, Genesca J, et al. Development of hyperdynamic circulation and response to beta-blockers in compensated cirrhosis with portal hypertension. Hepatology. 2016;63(1):197–206.
  • Oben JA, Roskams T, Yang S, et al. Hepatic fibrogenesis requires sympathetic neurotransmitters. Gut. 2004;53(3):438–445.
  • Trebicka J, Hennenberg M, Schulze PA, et al. Role of beta3-adrenoceptors for intrahepatic resistance and portal hypertension in liver cirrhosis. Hepatology. 2009;50(6):1924–1935.
  • Zacharias AP, Jeyaraj R, Hobolth L, et al. Carvedilol versus traditional, non-selective beta-blockers for adults with cirrhosis and gastroesophageal varices. Cochrane Database Syst Rev. 2018;(10):CD011510.
  • Malandris K, Paschos P, Katsoula A, et al. Carvedilol for prevention of variceal bleeding: a systematic review and meta-analysis. Ann Gastroenterol. 2019;32(3):287–297.
  • Hobolth L, Bendtsen F, Hansen EF, et al. Effects of carvedilol and propranolol on circulatory regulation and oxygenation in cirrhosis: a randomised study. Dig Liver Dis. 2014;46(3):251–256.
  • Trebicka J, von HM, Lehmann J, et al. Assessment of beta-blocker response by expression of beta-Arrestin2 and RhoA/ROCK2 in antrum mucosa in cirrhotic patients. J Hepatol. 2016;64(6):1265–1273.
  • Augustin S, Gonzalez A, Badia L, et al. Long-term follow-up of hemodynamic responders to pharmacological therapy after variceal bleeding. Hepatology. 2012;56(2):706–714.
  • Tripathi D, Hayes P. Beta blockers in portal hypertension: new developments and controversies. Liver Int. 2014;34(5):655–667.
  • Bendtsen F, Møller S, Krag A. Variceal rebleeding: drugs, endoscopy or both? In: de Franchis R, Dell’era A, editors. Variceal hemorrhage. 1st ed. London: Springer; 2014. p. 213–228.
  • Nevens F. Novel approaches to reducing the risk of variceal hemorrhage. Dig Dis. 2017;35(4):397–401.
  • Ioannou G, Doust J, Rockey DC. Terlipressin for acute esophageal variceal hemorrhage. Cochrane Database Syst Rev. 2003;(1):CD002147.
  • Zhou X, Tripathi D, Song T, et al. Terlipressin for the treatment of acute variceal bleeding: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(48):e13437.
  • Pose E, Trebicka J, Mookerjee RP, et al. Statins: old drugs as new therapy for liver diseases? J Hepatol. 2019;70(1):194–202.
  • Abraldes JG, Villanueva C, Aracil C, et al. Addition of simvastatin to standard therapy for the prevention of variceal rebleeding does not reduce rebleeding but increases survival in patients with cirrhosis. Gastroenterology. 2016;150(5):1160–1170.
  • Tripathi DM, Vilaseca M, Lafoz E, et al. Simvastatin prevents progression of acute on chronic liver failure in rats with cirrhosis and portal hypertension. Gastroenterology. 2018;155(5):1564–1577.
  • Schwabl P, Hambruch E, Seeland BA, et al. The FXR agonist PX20606 ameliorates portal hypertension by targeting vascular remodelling and sinusoidal dysfunction. J Hepatol. 2017;66(4):724–733.
  • Tandon P, Inayat I, Tal M, et al. Sildenafil has no effect on portal pressure but lowers arterial pressure in patients with compensated cirrhosis. Clin Gastroenterol Hepatol. 2010;8(6):546–549.
  • Tandon P, Abraldes JG, Berzigotti A, et al. Renin-angiotensin-aldosterone inhibitors in the reduction of portal pressure: a systematic review and meta-analysis. J Hepatol. 2010;52(2):273–282.
  • Shim KY, Eom YW, Kim MY, et al. Role of the renin-angiotensin system in hepatic fibrosis and portal hypertension. Korean J Intern Med. 2018;33(3):453–461.
  • Bernardi M, Moreau R, Angeli P, et al. Mechanisms of decompensation and organ failure in cirrhosis: from peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol. 2015;63(1272):1284.
  • Hernaez R, Sola E, Moreau R, et al. Acute-on-chronic liver failure: an update. Gut. 2017;66(3):541–553.
  • Møller S, Iversen JS, Henriksen JH, et al. Reduced baroreflex sensitivity in alcoholic cirrhosis:relations to hemodynamics and humoral systems. Am J Physiol Heart Circ Physiol. 2007;292(6):H2966–H2972.
  • Møller S, Mortensen C, Bendtsen F, et al. Cardiac sympathetic imaging with mIBG in cirrhosis and portal hypertension: relation to autonomic and cardiac function. Am J Physiol Gastrointest Liver Physiol. 2012;303(11):G1228–G1235.
  • Di SC, Milazzo V, Milan A, et al. The role of autonomic dysfunction in cirrhotic patients before and after liver transplantation. Review of the literature. Liver Int. 2016;36(8):1081–1089.
  • Tazi KA, Moreau R, Heller J, et al. Changes in protein kinase C isoforms in association with vascular hyporeactivity in cirrhotic rat aortas. Gastroenterology. 2000;119(1):201–210.
  • Ferlitsch A, Pleiner J, Mittermayer F, et al. Vasoconstrictor hyporeactivity can be reversed by antioxidants in patients with advanced alcoholic cirrhosis of the liver and ascites. Crit Care Med. 2005;33(9):2028–2033.
  • Wiest R, Groszmann RJ. Nitric oxide and portal hypertension: its role in the regulation of intrahepatic and splanchnic vascular resistance. Semin Liver Dis. 1999;19(04):411–426.
  • Tazi KA, Barriere E, Moreau R, et al. Role of shear stress in aortic eNOS up-regulation in rats with biliary cirrhosis. Gastroenterology. 2002;122(7):1869–1877.
  • Lopez-Talavera JC, Merrill WW, Groszmann RJ. Tumor necrosis factor alpha: a major contributor to the hyperdynamic circulation in prehepatic portal-hypertensive rats. Gastroenterology. 1995;108(3):761–767.
  • Munoz J, Albillos A, Perezparamo M, et al. Factors mediating the hemodynamic effects of tumor necrosis factor-alpha in portal hypertensive rats. Amer J Physiol Gastrointest L. 1999;39(3):G687–G693.
  • Reiberger T, Ferlitsch A, Payer BA, et al. Non-selective betablocker therapy decreases intestinal permeability and serum levels of LBP and IL-6 in patients with cirrhosis. J Hepatol. 2013;58(5):911–921.
  • Wiest R, Lawson M, Geuking M. Pathological bacterial translocation in liver cirrhosis. J Hepatol. 2014;60(1):197–209.
  • Bajaj JS, O’Leary JG, Wong F, et al. Bacterial infections in end-stage liver disease: current challenges and future directions. Gut. 2012;61(8):1219–1225.
  • Leithead JA, Ferguson JW, Bates CM, et al. The systemic inflammatory response syndrome is predictive of renal dysfunction in patients with non-paracetamol-induced acute liver failure. Gut. 2009;58(3):443–449.
  • Møller S, Henriksen JH, Bendtsen F. Ascites: pathogenesis and therapeutic principles. Scand J Gastroenterol. 2009;44(8):902–911.
  • Gines P, Angeli P, Lenz K, et al. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53(3):397–417.
  • Angeli P, Sanyal A, Møller S, et al. Current limits and future challenges in the management of renal dysfunction in patients with cirrhosis: report from the International Club of Ascites. Liver Int. 2013;33(1):16–23.
  • Schrier RW. Water and sodium retention in edematous disorders: role of vasopressin and aldosterone. Am J Med. 2006;119(7):S47–S53.
  • Henriksen JH, Kiszka-Kanowitz M, Bendtsen F, et al. Review article: volume expansion in patients with cirrhosis. Aliment Pharmacol Ther. 2002;16(s5):12–23.
  • Bernardi M, Santi L. Renal sodium retention in pre-ascitic cirrhosis: the more we know about the puzzle, the more it becomes intricate. J Hepatol. 2010;53(5):790–792.
  • Bosch J, Iwakiri Y. The portal hypertension syndrome: etiology, classification, relevance, and animal models. Hepatol Int. 2018;12(S1):1–10.
  • Claria J, Stauber RE, Coenraad MJ, et al. Systemic inflammation in decompensated cirrhosis: characterization and role in acute-on-chronic liver failure. Hepatology. 2016;64(4):1249–1264.
  • Liu H, Schuelert N, McDougall JJ, et al. Central neural activation of hyperdynamic circulation in portal hypertensive rats depends on vagal afferent nerves. Gut. 2008;57(7):966–973.
  • EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406–460.
  • Bureau C, Thabut D, Oberti F, et al. Transjugular Intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology. 2017;152(1):157–163.
  • Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology. 2008;48(6):2064–2077.
  • Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.
  • Møller S, Krag A, Bendtsen F. Kidney injury in cirrhosis: pathophysiological and therapeutic aspects of hepatorenal syndromes. Liver Int. 2014;34(8):1153–1163.
  • Angeli P, Garcia-Tsao G, Nadim MK, et al. News in pathophysiology, definition and classification of hepatorenal syndrome: a step beyond the International Club of Ascites (ICA) consensus document. J Hepatol. 2019;71(811):822.
  • Schrier RW, Shchekochikhin D, Gines P. Renal failure in cirrhosis: prerenal azotemia, hepatorenal syndrome and acute tubular necrosis. Nephrol Dial Transplant. 2012;27(7):2625–2628.
  • Gines P, Schrier RW. Renal failure in cirrhosis. N Engl J Med. 2009;361(13):1279–1290.
  • Serste T, Gustot T, Rautou PE, et al. Severe hyponatremia is a better predictor of mortality than MELDNa in patients with cirrhosis and refractory ascites. J Hepatol. 2012;57(2):274–280.
  • Piano S, Tonon M, Angeli P. Management of ascites and hepatorenal syndrome. Hepatol Int. 2018;12(S1):122–134.
  • Bernardi M, Caraceni P. Novel perspectives in the management of decompensated cirrhosis. Nat Rev Gastroenterol Hepatol. 2018;15(12):753–764.
  • Stadlbauer VP, Wright GA, Banaji M, et al. Relationship between activation of the sympathetic nervous system and renal blood flow autoregulation in cirrhosis. Gastroenterology. 2008;134(1):111–119.
  • Schmidt LE, Ring-Larsen H. Vasoconstrictor therapy for hepatorenal syndrome in liver cirrhosis. CPD. 2006;12(35):4637–4647.
  • Mattos AZ, Schacher FC, Mattos AA. Vasoconstrictors in hepatorenal syndrome – a critical review. Ann Hepatol. 2019;18(2):287–290.
  • Israelsen M, Krag A, Allegretti AS, et al. Terlipressin versus other vasoactive drugs for hepatorenal syndrome. Cochrane Database Syst Rev. 2017;(9):CD011532.
  • Krag A, Møller S. Safety of terlipressin for hepatorenal syndrome. In: Gerbes A, editor. Ascites, hyponatremia and hepatrenal syndrome: progress in treatment. 1st ed. Basel: Karger; 2011. p. 178–188.
  • Francoz C, Durand F, Kahn JA, et al. Hepatorenal syndrome. CJASN. 2019;14(5):774–781.
  • Krag A, Bendtsen F, Pedersen EB, et al. Effects of terlipressin on the aquaretic system – evidence of antidiuretic effects. Am J Physiol Renal Physiol. 2008;295(5):F1295–F1300.
  • Paine CH, Biggins SW, Pichler RH. Albumin in cirrhosis: more than a colloid. Curr Treat Options Gastro. 2019;17(2):231–243.
  • Wong F, Watson H, Gerbes A, et al. Satavaptan for the management of ascites in cirrhosis: efficacy and safety across the spectrum of ascites severity. Gut. 2012;61(1):108–116.
  • Lehrich RW, Ortiz-Melo DI, Patel MB, et al. Role of vaptans in the management of hyponatremia. Am J Kidney Dis. 2013;62(2):364–376.
  • Cartin-Ceba R, Krowka MJ. Pulmonary complications of portal hypertension. Clin Liver Dis. 2019;23(4):683–711.
  • Raevens S, Geerts A, Van Steenkiste C, et al. Hepatopulmonary syndrome and portopulmonary hypertension: recent knowledge in pathogenesis and overview of clinical assessment. Liver Int. 2015;35(6):1646–1660.
  • Zhang M, Luo B, Chen SJ, et al. Endothelin-1 stimulation of endothelial nitric oxide synthase in the pathogenesis of hepatopulmonary syndrome. Am J Physiol. 1999;277(5):G944–G952.
  • Luo B, Liu L, Tang L, et al. Increased pulmonary vascular endothelin B receptor expression and responsiveness to endothelin-1 in cirrhotic and portal hypertensive rats: a potential mechanism in experimental hepatopulmonary syndrome. J Hepatol. 2003;38(5):556–563.
  • Zhang J, Ling Y, Luo B, et al. Analysis of pulmonary heme oxygenase-1 and nitric oxide synthase alterations in experimental hepatopulmonary syndrome. Gastroenterology. 2003;125(5):1441–1451.
  • Söderman C, Leone A, Furst V, et al. Endogenous nitric oxide in exhaled air from patients with liver cirrhosis. Scand J Gastroenterol. 1997;32(6):591–597.
  • Afzelius P, Bazeghi N, Bie P, et al. Circulating nitric oxide products do not solely reflect nitric oxide release in cirrhosis and portal hypertension. Liver Int. 2011;31(9):1381–1387.
  • Arguedas MR, Drake BB, Kapoor A, et al. Carboxyhemoglobin levels in cirrhotic patients with and without hepatopulmonary syndrome. Gastroenterology. 2005;128(2):328–333.
  • Raevens S, Geerts A, Paridaens A, et al. Placental growth factor inhibition targets pulmonary angiogenesis and represents a therapy for hepatopulmonary syndrome in mice. Hepatology. 2018;68(2):634–651.
  • Horvatits T, Drolz A, Roedl K, et al. vWF, a screening tool for detection of hepatopulmonary syndrome in patients with liver cirrhosis. J Hepatol. 2014;61(3):544–549.
  • Raevens S, Fallon MB. Potential clinical targets in hepatopulmonary syndrome: lessons from experimental models. Hepatology. 2018;68(5):2016–2028.
  • Brussino L, Bucca C, Morello M, et al. Effect on dyspnoea and hypoxaemia of inhaled N(G)-nitro-L-arginine methyl ester in hepatopulmonary syndrome. Lancet. 2003;362(9377):43–44.
  • Gomez FP, Barbera JA, Roca J, et al. Effects of nebulized N(G)-nitro-L-arginine methyl ester in patients with hepatopulmonary syndrome. Hepatology. 2006;43(5):1084–1091.
  • Gupta S, Faughnan ME, Lilly L, et al. Norfloxacin therapy for hepatopulmonary syndrome: a pilot randomized controlled trial. Clin Gastroenterol Hepatol. 2010;8(12):1095–1098.
  • Liu L, Liu N, Zhao Z, et al. TNF-alpha neutralization improves experimental hepatopulmonary syndrome in rats. Liver Int. 2012;32(6):1018–1026.
  • Rodriguez-Roisin R, Krowka MJ, Herve P, et al. Pulmonary-hepatic vascular disorders (PHD). Eur Respir J. 2004;24(5):861–880.
  • Roberts KE, Fallon MB, Krowka MJ, et al. Genetic risk factors for portopulmonary hypertension in patients with advanced liver disease. Am J Respir Crit Care Med. 2009;179(9):835–842.
  • Cody RJ, Haas GJ, Binkley PF, et al. Plasma endothelin correlates with the extent of pulmonary hypertension in patients with chronic congestive heart failure. Circulation. 1992;85(2):504–509.
  • Barnes PJ. Endothelins and pulmonary diseases. J Appl Physiol. 1994;77(3):1051–1059.
  • Talwalkar JA, Swanson KL, Krowka MJ, et al. Prevalence of spontaneous portosystemic shunts in patients with portopulmonary hypertension and effect on treatment. Gastroenterology. 2011;141(5):1673–1679.
  • Machicao VI, Balakrishnan M, Fallon MB. Pulmonary complications in chronic liver disease. Hepatology. 2014;59(4):1627–1637.
  • AbuHalimeh B, Krowka MJ, Tonelli AR. Treatment barriers in portopulmonary hypertension. Hepatology. 2019;69(1):431–443.
  • Kuntzen C, Gulberg V, Gerbes AL. Use of a mixed endothelin receptor antagonist in portopulmonary hypertension: a safe and effective therapy? Gastroenterology. 2005;128(1):164–168.
  • Hoeper MM, Halank M, Marx C, et al. Bosentan therapy for portopulmonary hypertension. Eur Respir J. 2005;25(3):502–508.
  • Reichenberger F, Voswinckel R, Steveling E, et al. Sildenafil treatment for portopulmonary hypertension. Eur Respir J. 2006;28(3):563–567.
  • Simbrunner B, Mandorfer M, Trauner M, et al. Gut-liver axis signaling in portal hypertension. Wjg. 2019;25(39):5897–5917.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.