Fanous, John

ABSTRACTHepatopulmonary syndrome (HPS) poses a significant challenge in liver transplant recipients, mostly resulting in persistent hypoxaemia postoperatively. We present the case of a 59‐year‐old male with decompensated metabolic dysfunction associated with steatohepatitis (MASH) cirrhosis, who had liver transplantation due to end‐stage liver disease complicated by HPS‐related hypoxaemia. Despite successful transplantation, the patient continued to experience severe hypoxaemia, requiring high supplemental oxygen despite maximal conservative treatment per guidelines. Potential causes for hypoxaemia post‐liver transplant have been excluded; HPS as the sole cause of hypoxaemia was proved with a repeat shunt study, which estimated the shunt at 59%. Treatment with inhaled Treprostinil led to a remarkable improvement in oxygenation, facilitating the successful weaning of oxygen supplementation. The patient's hypoxaemia improved to full recovery upon discharge. This case highlights the persistence of hypoxaemia post‐liver transplantation in HPS patients and underscores the potential role of inhaled Treprostinil as a novel therapeutic approach to address this complication.