Coexistence of hepatopulmonary syndrome and portopulmonary hypertension before a liver transplantation: a case report and review of the literature

Liver transplantation remains the treatment of choice for hepatopulmonary syndrome (HPS) with severe hypoxemia, but portopulmonary hypertension (PoPH) has traditionally been viewed as a contraindication to liver transplantation owing to its frequent posttransplant deterioration. We describe here the sequential presence of both pulmonary vascular disorders in a cirrhotic patient in the pretransplant period. Liver transplantation was made possible following effective management of pulmonary hypertension, with favorable outcome 3 years post-liver transplantation. Finally, our case report and literature review suggest that the coexistence of HPS and PoPH in patients with advanced liver disease could be more common than previously recognized.