Perioperative Anesthetic Management of Living Donor Liver Transplantation in a Child with Extrahepatic Portal Vein Obstruction & Hepatopulmonary Syndrome: A Case Report

Abstract

Hepatopulmonary syndrome (HPS) in children with extrahepatic portal vein obstruction (EHPVO) is a rare but life-threatening complication associated with severe hypoxemia and elevated perioperative risk during liver transplantation. We report the perioperative anesthetic management of a 6-year-old male with EHPVO complicated by  HPS, presenting with room air oxygen saturation of 77–79%, who underwent living donor liver transplantation (LDLT). An integrative approach incorporating meticulous oxygenation optimization, invasive hemodynamic monitoring, targeted reperfusion management, and planned postoperative mechanical ventilation resulted in successful extubation on postoperative day 1 and intensive care unit discharge on day 6 undergoing Modified Radical Mastectomy.