Overcoming Intrapulmonary Shunting: A Case Report of Hepatopulmonary Syndrome Post-Liver Transplantation Treated With Inhaled Treprostinil.

Hepatopulmonary syndrome (HPS) poses a significant challenge in liver transplant recipients, mostly resulting in persistent hypoxaemia postoperatively. We present the case of a 59-year-old male with decompensated metabolic dysfunction associated with steatohepatitis (MASH) cirrhosis, who had liver transplantation due to end-stage liver disease complicated by HPS-related hypoxaemia. Despite successful transplantation, the patient continued to experience severe hypoxaemia, requiring high supplemental oxygen despite maximal conservative treatment per guidelines. Potential causes for hypoxaemia post-liver transplant have been excluded; HPS as the sole cause of hypoxaemia was proved with a repeat shunt study, which estimated the shunt at 59%. Treatment with inhaled Treprostinil led to a remarkable improvement in oxygenation, facilitating the successful weaning of oxygen supplementation. The patient's hypoxaemia improved to full recovery upon discharge. This case highlights the persistence of hypoxaemia post-liver transplantation in HPS patients and underscores the potential role of inhaled Treprostinil as a novel therapeutic approach to address this complication.