Liver transplantation for massive hepatic haemangiomatosis causing restrictive lung disease

A 34-yr-old man with hepatic haemangiomatosis presented for orthotopic live r transplantation. His massively distended abdomen caused thoracic compress ion and severe restrictive lung disease. Respiratory failure was the princi pal indication for transplantation. Increased airway pressures, pulmonary h ypertension, systemic hypotension caused by aorto-caval compression, and bl ood loss, complicated the intra-operative anaesthetic management. Weaning f rom mechanical ventilation was impaired by acute and chronic metabolic alka losis, and diaphragmatic laxity.