Pulmonary contraindications, indications and MELD exceptions for liver transplantation: a contemporary view and look forward

Abstract

Pulmonary concerns in liver transplant candidates have intraoperative and outcome implications. Evolving MELD exception policies address transplant priority for problems such as hepatopulmonary syndrome, portopulmonary hypertension, and hemorrhagic hereditary telangiectasia. Other pulmonary issues such as refractory hepatic hydrothorax, advanced chronic obstructive lung disease (including alpha-1 antitrypsin deficiency) and indeterminate pulmonary nodules may affect liver transplant consideration. Herein, we discuss current pulmonary-related contraindications, indications and MELD exception policies for liver transplantation, suggesting future considerations.

Keywords: AATD; Alpha-1 antitrypsin deficiency; CO; COPD; CT; FDG; FEV(1); FVC; HCC; HH; HHT; HPS; HVM; Hepatic hydrothorax; Hepatopulmonary syndrome; Hereditary hemorrhagic telangiectasia; ILD; IPF; LT; MELD; MPAP; OPTN; Organ Procurement and Transplant Network; PBC; PCWP; PET; POPH; PVR; Portopulmonary hypertension; Pulmonary nodules; REVEAL; RHH; RV; SRTR; TIPS; TPG; TcMAA; alpha-1 antitrypsin deficiency; cardiac output; chronic obstructive pulmonary disease; computed tomography; fluorine-18 fluorodeoxyglucose; forced expiratory volume in one second; forced vital capacity; hepatic hydrothorax; hepatic vascular malformations; hepatocellular carcinoma; hepatopulmonary syndrome; hereditary hemorrhagic telangiectasia; idiopathic pulmonary fibrosis; interstitial lung disease; liver transplantation; mean pulmonary artery pressure; model for end stage liver disease; portopulmonary hypertension; positron emission tomography; primary biliary cirrhosis; pulmonary capillary wedge pressure; pulmonary vascular resistance; refractory hepatic hydrothorax; registry to evaluate early and long-term pulmonary artery hypertension; right ventricle; scientific registry for transplant recipients; technetium macroaggregated albumin; transjugular intrahepatic portosystemic shunt; transpulmonary gradient.