Outcomes of Patients With Severe and Very Severe Hepatopulmonary Syndrome After Liver Transplantation at a High‐Volume Transplant Center: A Case Series Hepatopulmonary Syndrome Post‐Transplant

ABSTRACT Hepatopulmonary syndrome (HPS) affects up to one‐third of patients with advanced chronic liver disease (ACLD) and is an independent risk factor for increased mortality. While HPS often improves following liver transplantation, patients with severe or very severe HPS—classified by partial pressure of arterial oxygen (PaO 2 ) <60 mmHg—face higher post‐transplant complications and mortality. However, evidence suggests that even patients with severe HPS may benefit from liver transplantation when performed at high‐volume centers. To assess post‐transplant outcomes in this population, we conducted a retrospective chart review of 20 patients diagnosed with severe or very severe HPS who underwent liver transplantation at Mayo Clinic Hospital in Arizona between 2014 and 2024. The most common post‐transplant complication was persistent hypoxemia, managed on a case‐by‐case basis with various treatments, though no single approach proved consistently superior. All patients who received transplants demonstrated improvement; 84% of patients ultimately discontinued supplemental oxygen, with a mean time of 250 days (range: 0–1113 days). Time was the key factor in recovery. Notably, no deaths in our cohort were directly attributed to HPS. These findings support liver transplantation as a viable treatment option for HPS, even in severe cases, and underscore the importance of experienced transplant centers in optimizing patient outcomes.