Pulmonary abnormalities in liver disease: relevance to transplantation and outcome.

Raevens, Sarah; Boret, Maxine; De Pauw, Michel; Fallon, Michael B; Van Vlierberghe, Hans

Pulmonary disease in liver cirrhosis and portal hypertension constitutes a challenging clinical scenario and may have important implications with regard to prognosis, liver transplantation (LT) candidacy and post-LT outcome. Pre-LT evaluation should include adequate screening for pulmonary diseases that may occur concomitantly with liver disease as well as for those that may arise as a complication of end-stage liver disease and portal hypertension, as either may jeopardize safe LT and successful outcome. It is key to discriminate those patients who would benefit from LT, especially pulmonary disorders that have been reported to resolve post-LT and are considered 'pulmonary indications' for transplant, from those who are at increased mortality risk and in whom LT is contraindicated. In conclusion, in this manuscript, we review the impact of several pulmonary disorders, including cystic fibrosis, alpha 1-antitrypsin deficiency, hereditary hemorrhagic telangiectasia, sarcoidosis, COVID-19, asthma, chronic obstructive pulmonary disease, pulmonary nodules, interstitial lung disease, hepatic hydrothorax, hepatopulmonary syndrome and portopulmonary hypertension, on post-LT survival, as well as the reciprocal impact of LT on the evolution of lung function.