2004 Volume 49 Issue 1+2 Pages 51-54
A six-year-old girl with biliary atresia underwent a living donor liver transplantation because of deteriorating intrapulmonary shunting related to portal hypertension. Following transplantation, the patient's oxygenation improved after the tenth postoperative day and returned to normal within thirty days. The important points of early post-transplantation management for intrapulmonary shunting are as follows: 1) coping with large volume of sputum and thus, if necessary, a prompt tracheotomy should be performed; 2) when dealing with persistent hypoxemia, it is essential to maintain the preoperative oxygenation levels and avoid any outflow disturbance of the graft liver; and 3) the prevention of the fatal vascular thrombosis. Phlebotomy to correct the presence of underlying polycythemia is also required.