Use of transjugular intrahepatic portosystemic shunt as a bridge to liver transplantation in a patient with severe hepatopulmonary syndrome

Hepatopulmonary syndrome (HPS) is defined by the presence of the triad of l iver disease, arterial hypoxemia, and intrapulmonary vascular dilatation. T he clinical implication of this disorder is impairment of gas exchange. Num erous reports in the literature show that this condition is reversible with orthotopic liver transplantation (OLT). However, patients with HPS often p resent with Pa-O2 levels that are quite low. OLT with a preoperative Pa-O2 less than 50 mm Hg is associated with unacceptably high mortality and morbi dity. We report a case of severe HPS in which a transjugular intrahepatic p ortosystemic shunt was successfully used to improve oxygenation, thus allow ing a successful elective OLT.