{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:10:59Z","timestamp":1790791859876,"version":"4.1.0"},"reference-count":51,"publisher":"European Respiratory Society (ERS)","issue":"2","license":[{"start":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T00:00:00Z","timestamp":1640217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.ersjournals.com\/user-licence"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["HL113988, K24 HL103844, K23 DK090209, K23-HL141584"],"award-info":[{"award-number":["HL113988, K24 HL103844, K23 DK090209, K23-HL141584"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2021,11,30]]},"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Hepatopulmonary syndrome affects 10\u201330% of patients with cirrhosis and portal hypertension. We evaluated the serum angiogenic profile of hepatopulmonary syndrome and assessed the clinical impact of hepatopulmonary syndrome in patients evaluated for liver transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Pulmonary Vascular Complications of Liver Disease 2 study was a multicentre, prospective cohort study of adults undergoing their first liver transplantation evaluation. Hepatopulmonary syndrome was defined as an alveolar\u2013arterial oxygen gradient \u226515\u2005mmHg (\u226520\u2005mmHg if age &gt;64\u2005years), positive contrast-enhanced transthoracic echocardiography and absence of lung disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 85 patients with hepatopulmonary syndrome and 146 patients without hepatopulmonary syndrome. Patients with hepatopulmonary syndrome had more complications of portal hypertension and slightly higher Model for End-Stage Liver Disease-Na score compared to those without hepatopulmonary syndrome (median (interquartile range) 15 (12\u201319)<jats:italic>versus<\/jats:italic>14 (10\u201317), p=0.006). Hepatopulmonary syndrome patients had significantly lower 6-min walk distance and worse functional class. Hepatopulmonary syndrome patients had higher circulating angiopoietin 2, Tie2, tenascin C, tyrosine protein kinase Kit (c-Kit), vascular cell adhesion molecule 1 and von Willebrand factor levels, and lower E-selectin levels. Patients with hepatopulmonary syndrome had an increased risk of death (hazard ratio 1.80, 95% CI 1.03\u20133.16, p=0.04), which persisted despite adjustment for covariates (hazard ratio 1.79, 95% CI 1.02\u20133.15, p=0.04). This association did not vary based on levels of oxygenation, reflecting the severity of hepatopulmonary syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Hepatopulmonary syndrome was associated with a profile of abnormal systemic angiogenesis, worse exercise and functional capacity, and an overall increased risk of death.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.02304-2021","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T18:35:29Z","timestamp":1640284529000},"page":"2102304","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":32,"title":["Impact of hepatopulmonary syndrome in liver transplantation candidates and the role of angiogenesis"],"prefix":"10.1183","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7896-0608","authenticated-orcid":false,"given":"Steven 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