Pulmonary Hypertension Post Liver-Kidney Transplant

Porto-pulmonary hypertension has been recently recognized in patients post-liver transplantation with or without pre-transplant hepatopulmonary syndrome. We present a unique case of pulmonary hypertension in a 65-year-old patient after simultaneous liver-kidney transplantation for cirrhosis secondary to chronic hepatitis C infection and alcohol use disorder and end-stage renal disease secondary to diabetic nephropathy. He presented to pulmonary hypertension clinic with progressive shortness of breath and elevated right-sided pulmonary pressures on echocardiogram. He did not have pre-transplant hepatopulmonary syndrome and his post-transplant liver and kidney functions were normal. His right heart catheterization showed normal capillary wedge pressure, elevated mean pulmonary artery pressure and high pulmonary vascular resistance with normal cardiac index. His symptoms and pulmonary pressures improved with ligation of AV fistula.