title: Severe portopulmonary hypertension after liver transplantation in a patient with preexisting hepatopulmonary syndrome.
abstract: BACKGROUND
  Portopulmonary hypertension and hepatopulmonary syndrome have been considered mutually exclusive pulmonary vascular disorders in liver disease states.
  
  
  METHODS
  This current report describes a middle-aged patient, a candidate for liver transplantation, diagnosed with hepatopulmonary syndrome on the basis of clinical, echocardiographic and gas exchange criteria. Unusually high pulmonary pressures were observed at liver transplantation, performed 6 months after the initial diagnosis of hepatopulmonary syndrome. Three months later, the patient developed severe pulmonary hypertension and died of right ventricular failure during a second attempted liver transplantation. Postmortem histologic findings in the lung confirmed the presence of plexogenic pulmonary arteriopathy.
  
  
  CONCLUSIONS
  This case illustrates the potential occurrence of hepatopulmonary syndrome and portopulmonary hypertension in the same patient, suggesting that the presence of hepatopulmonary syndrome may not preclude the development of portopulmonary hypertension.
authors.affiliation: Servei d'Anestesiología i Reanimació, Hospital Clínic, Universitat de Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Martinez-Pallí
authors.forename: J A
authors.initials: JA
authors.lastname: Barberà
authors.forename: P
authors.initials: P
authors.lastname: Taurà
authors.forename: I
authors.initials: I
authors.lastname: Cirera
authors.forename: J
authors.initials: J
authors.lastname: Visa
authors.forename: R
authors.initials: R
authors.lastname: Rodriguez-Roisin
mesh_terms: D020065:Hepatopulmonary Syndrome; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged