[A Case of Liver-transplant Recipient who Developed Aggravation of Pulmonary Hypertension during Anhepatic Phase].

Portopulmonary hypertension is a form of pulmo- nary hypertension associated with portal hypertension with/without liver cirrhosis. We describe a case of liver-transplant recipient who developed aggravation of pulmonary hypertension during anhepatic phase of operation. A 31-year-old man with progressive liver failure was scheduled for liver transplantation. He had a history of biliary atresia and underwent Ueda's operation. The patient was diagnosed as having portopulmonary hypertension. Echocardiography revealed pulmonary hypertension. Pulmonary arterial pressure (PAP) mea- sured by right heart catheterization was 52/22 mmHg, which decreased with oxygen inhalation. General anesthesia was induced by infusion of pro- pofol and remifentanil. Arterial pressure (AP) and PAP immediately before surgery were 99/44 mmHg and 51/26 mmHg, respectively. Hemodynamic parameters were stable during hepatectomy phase. During unhepatic phase, PAP and cardiac index gradually increased and AP gradually decreased. The development of hyperdynamic state was suspected, and continuous administration of noradrenaline was commenced. AP was restored ; however, PAP kept increasing to an extent comparable to AP. Inhalation of nitric oxide (NO) 20 ppm was commenced, and then PAP successfully decreased to 46/26 mmHg within 15 minutes. After surgery the patient was mechanically ventilated in the ICU. NO was stopped on the 11th ICU day and extubated on the 13th ICU day.