Resolving impaired response to exercise in hepatopulmonary syndrome after liver transplantation

A series of graded cardiopulmonary exercise tests (CPET) in a patient with hepatopulmonary syndrome (HPS) who was evaluated before and after liver transplantation are described. HPS associated with marked dyspnea, results from abnormal intrapulmonary vascular dilatation with rapid transit of the blood in the pulmonary vascular bed, creating right-to-left shunt and hypoxemia. Decreased peak oxygen uptake, wasted ventilation and hypoxemia were corrected within 8 months after the transplant, thus making CPET a very useful tool for investigating and following these patients before and after transplant.