{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:41:14Z","timestamp":1760146874992,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,29]],"date-time":"2024-12-29T00:00:00Z","timestamp":1735430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background: Hepatopulmonary syndrome (HPS), defined by the presence of pulmonary vascular dilatations that cause right-to-left transpulmonary shunting of venous blood with a consequential increase in the alveolar\u2013arterial oxygen gradient, is a relatively frequent complication of chronic liver disease. While orthotopic liver transplantation (OLT) is indicated and often curative in HPS patients with end-stage liver disease (ESLD), little is known about the peri- and post-operative-period risks of CVA in OLT recipients with HPS. Case Presentation: We report a case series of five non-consecutive OLT recipients with HPS who developed ischemic and\/or hemorrhagic CVAs during or shortly after OLT, raising concern that the risks of neurological complications remain increased even after OLT. Conclusions: Our case series hopes to highlight the importance of close vigilance in this subset of patients, at a time when there may be multiple issues to be addressed in facilitating post-operative recovery.<\/jats:p>","DOI":"10.3390\/clinpract15010005","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T14:21:12Z","timestamp":1735654872000},"page":"5","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cerebrovascular Accidents After Orthotopic Liver Transplantation in Patients with Hepatopulmonary Syndrome: A Case Series"],"prefix":"10.3390","volume":"15","author":[{"given":"Steffi K.","family":"Chan","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel M.","family":"Buitrago Blanco","sequence":"additional","affiliation":[{"name":"Division of Neurocritical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas J.","family":"Feduska","sequence":"additional","affiliation":[{"name":"Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vatche G.","family":"Agopian","sequence":"additional","affiliation":[{"name":"Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4397-0482","authenticated-orcid":false,"given":"Samer S.","family":"Ebaid","sequence":"additional","affiliation":[{"name":"Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tisha","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0814-161X","authenticated-orcid":false,"given":"Ami","family":"Tamhaney","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8096-0858","authenticated-orcid":false,"given":"Igor","family":"Barjaktarevic","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1136\/gut.51.6.853","article-title":"Hepatopulmonary syndrome: Prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences","volume":"51","author":"Schenk","year":"2002","journal-title":"Gut"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1053\/j.gastro.2008.12.001","article-title":"Pulmonary Angiogenesis in a Rat Model of Hepatopulmonary Syndrome","volume":"136","author":"Zhang","year":"2009","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1016\/0016-5085(95)90589-8","article-title":"Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome","volume":"109","author":"Abrams","year":"1995","journal-title":"Gastroenterology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1053\/j.gastro.2008.06.038","article-title":"Impact of Hepatopulmonary Syndrome on Quality of Life and Survival in Liver Transplant Candidates","volume":"135","author":"Fallon","year":"2008","journal-title":"Gastroenterology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"415109","DOI":"10.1155\/2014\/415109","article-title":"The Successful Use of Inhaled Nitric Oxide in the Management of Severe Hepatopulmonary Syndrome after Orthotopic Liver Transplantation","volume":"2014","author":"Santos","year":"2014","journal-title":"Case Reports Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1055\/s-0038-1675333","article-title":"Perioperative Considerations in Liver Transplantation","volume":"39","author":"Barjaktarevic","year":"2018","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_7","first-page":"225","article-title":"Brain Abscess in Hepatopulmonary Syndrome","volume":"29","author":"Molleston","year":"1999","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1212\/CPJ.0000000000000454","article-title":"Multifocal stroke with proliferation of small cerebral arteries in hepatopulmonary syndrome","volume":"8","author":"Younce","year":"2018","journal-title":"Neurol. Clin. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"786","DOI":"10.2169\/internalmedicine.31.786","article-title":"Recurrent Intracranial Hemorrhagic Episodes in Hepatopulmonary Syndrome","volume":"31","author":"Shijo","year":"1992","journal-title":"Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1111\/j.1600-6143.2007.02124.x","article-title":"OPTN Policy Regarding Prioritization of Patients with Hepatopulmonary Syndrome: Does It Provide Equitable Organ Allocation?","volume":"8","author":"Sulieman","year":"2008","journal-title":"Am. J. Transplant."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1002\/ana.410080222","article-title":"Hepatic cirrhosis and intracranial hemorrhage: Significance of the association in 53 pathological cases","volume":"8","author":"Boudouresques","year":"1980","journal-title":"Ann. Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/S0016-5085(03)01207-1","article-title":"Prognostic significance of the hepatopulmonary syndrome in patients with cirrhosis","volume":"125","author":"Schenk","year":"2003","journal-title":"Gastroenterology"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kwon, H., Shin, S., Baek, C.H., Chang, J.Y., Kang, D.-W., Kwon, S.U., Kim, J.S., and Kim, B.J. (2023). Characteristics of stroke after liver and kidney transplantation. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1123518"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/01.tp.0000269090.90068.0f","article-title":"A Cause-Specific Hazard Rate Analysis of Prognostic Factors Among 877 Adults Who Received Primary Orthotopic Liver Transplantation","volume":"84","author":"Gaynor","year":"2007","journal-title":"Transplantation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1097\/TP.0000000000002899","article-title":"Intraoperative Hypertension and Thrombocytopenia Associated With Intracranial Hemorrhage After Liver Transplantation","volume":"104","author":"Gao","year":"2020","journal-title":"Transplantation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"443","DOI":"10.4065\/70.5.443","article-title":"Intracerebral Hemorrhage in Liver Transplant Recipients","volume":"70","author":"Wijdicks","year":"1995","journal-title":"Mayo Clin. Proc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2378","DOI":"10.1056\/NEJMra0707185","article-title":"Hepatopulmonary syndrome\u2014A liver-induced lung vascular disorder","volume":"358","author":"Krowka","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1056\/NEJM196602102740601","article-title":"Arterial Changes in the Lungs in Cirrhosis of the Liver\u2014Lung Spider Nevi","volume":"274","author":"Berthelot","year":"1966","journal-title":"N. Engl. J. Med."},{"key":"ref_19","first-page":"e000571","article-title":"Acute Ischemic Stroke in Patients With Pulmonary Arteriovenous Malformations: Paradoxical Embolism or Epiphenomenon?","volume":"3","author":"Das","year":"2023","journal-title":"Stroke: Vasc. Interv. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1164\/ajrccm.158.2.9711041","article-title":"Pulmonary arteriovenous malformations: A state of the art review","volume":"158","author":"Gossage","year":"1998","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_21","first-page":"e42756","article-title":"Bilateral Arteriovenous Shunting Through Pial and Perforating Vessels With Multiple Strokes in a Patient With Hepatopulmonary Syndrome","volume":"15","author":"Aljeradat","year":"2023","journal-title":"Cureus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1161\/01.STR.18.2.311","article-title":"Cerebral amyloid angiopathy. A critical review","volume":"18","author":"Vinters","year":"1987","journal-title":"Stroke"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1212\/CPJ.0000000000000593","article-title":"Multiple recurrent intracerebral hemorrhages and hepatopulmonary syndrome","volume":"9","author":"Carvalho","year":"2019","journal-title":"Neurol. Clin. Pract."}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/15\/1\/5\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:55:53Z","timestamp":1760115353000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/15\/1\/5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,29]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["clinpract15010005"],"URL":"https:\/\/doi.org\/10.3390\/clinpract15010005","relation":{},"ISSN":["2039-7283"],"issn-type":[{"type":"electronic","value":"2039-7283"}],"subject":[],"published":{"date-parts":[[2024,12,29]]}}}