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Inhaled nitric oxide improves the hepatopulmonary syndrome: a physiologic analysis
  1. Samir Gupta1,2,3,
  2. Rosalind Tang3,4,
  3. Abdul Al-Hesayen1,5
  1. 1 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2 Division of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
  3. 3 Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Ontario, Canada
  4. 4 Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
  5. 5 Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Samir Gupta, St Michael's Hospital, Toronto M5B 1W8, Ontario, Canada; Samir.Gupta{at}


The hepatopulmonary syndrome (HPS) is defined by liver dysfunction, intrapulmonary vasodilatation and abnormal oxygenation. Hypoxaemia is progressive and liver transplant is the only effective treatment. Severe hypoxaemia is a life-threatening HPS complication, particularly after transplant. We evaluated gas-exchange and haemodynamic effects of invasive therapies in a consecutive sample of 26 pre-transplant patients. Inhaled nitric oxide significantly improved partial pressure of oxygen (12.4 mm Hg; p=0.001) without deleterious effects on cardiac output. Trendelenburg positioning resulted in a small improvement, and methylene blue did not, though individual responses were variable. Future studies should prospectively evaluate these strategies in severe post-transplant hypoxaemia.

  • critical care
  • lung physiology
  • rare lung diseases

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  • Contributors SG and AA-H designed the study and acquired the data. SG and RT analysed the data and drafted the work. All authors revised the work for important intellectual content and approved the final version.

  • Funding This study was funded by the Michael Locke Term Chair in Knowledge Translation and Rare Lung Disease Research.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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