Trendelenburg positioning and continuous lateral rotation improve oxygenation in hepatopulmonary syndrome after liver transplantation

Hepatopulmonary syndrome (HPS) is characterized by hypoxia, orthodeoxia, an d platypnea, associated with severe chronic liver disease. Liver transplant ation is generally viewed as the only curative treatment for this syndrome, but it may be complicated by prolonged hypoxia after the procedure. We rep ort on a 58-year-old female patient with alcoholic cirrhosis and HPS who un derwent liver transplantation. She developed severe hypoxia after transplan tation that improved with the initiation of Trendelenburg's positioning in combination with continuous lateral rotation. Although many techniques for dealing with posttransplant hypoxia for HPS have been described, positionin g is a simple maneuver that may correct the pathophysiologic abnormalities seen in HPS by gravitationally shifting blood away from the lung bases to i mprove oxygenation. Although this represents a single patient, the results were reproducible, and the intervention is simple and associated with minim al potential complications. The authors think this is a useful intervention to apply to the severely hypoxic patient with HPS, and a trial with more p atients is warranted. (C) 1998 by the American Association for the Study of Liver Diseases.