The clinical research of Michael J. Krowka, M.D., broadly covers the lung abnormalities that are caused by or are associated with liver disease. These problems affect both children and adults. The lung abnormalities can be very important in that the decisions to proceed or not proceed with liver transplantation may depend on the specific lung problems that have developed.
Dr. Krowka's research projects involve patients at Mayo Clinic's campuses in Minnesota, Arizona and Florida.
- Hepatopulmonary syndrome (HPS). This is a liver-induced pulmonary vasodilation problem causing severely low oxygen levels in the blood. No medication can improve this problem. The severity of HPS is not related to the severity of liver disease. Investigation focuses on the causes of this problem that may relate to substances affected by diseased liver that dilate blood vessels and likely allow an increased number of blood vessels within the lung.
- Portopulmonary hypertension (POPH). This is a liver-induced pulmonary vasoconstriction problem causing pulmonary artery high blood pressure and right heart failure. Medical treatments can dramatically improve the blood pressure and thus allow safe liver transplant in some patients. POPH is not related to the severity of liver disease. Investigation focuses on the causes of the problem, which may relate to substances that narrow the lung blood vessels and are not cleared from the blood by a diseased liver.
- Alpha-1 antitrypsin deficiency. This inherited disorder can cause deficiency of a circulating protein that protects the lung. Deficiency of this blood protein (caused by accumulation in the liver cells that causes cirrhosis and the need for liver transplantation) results in lung damage, mainly emphysema. Investigation focuses on normalization of the blood protein level after liver transplantation and subsequent effect on the lungs.
Significance to patient care
Liver transplantation can totally resolve these syndromes, but complications before and after transplant are more frequent and related to the severity of the low oxygen level (HPS) and severity of high blood pressure in the lungs (POPH). Dr. Krowka and his colleagues seek medical therapies to improve pre- and post-liver transplant outcomes.
In alpha-1 antitrypsin deficiency, liver transplant can effectively cure the liver damage. The long-term effect of the new liver on the lungs is unknown since abnormal alpha-1 protein can still be made by some lung cells and cause lung damage. Dr. Krowka's group is studying ways to prevent further lung deterioration if it does occur.
- Member, Editorial Board, Liver Transplantation, 2010-2013
- Member, Board of Directors, Alpha-1 Association, 2008-2013