Anaesthesia for caesarean section in a patient with Budd–Chiari syndrome and hepatopulmonary syndrome post liver transplantation

Hepatopulmonary syndrome is characterised by hypoxaemia and intrapulmonary shunting in the presence of portal hypertension. It is uncommon in the obstetric population but may occur in patients with Budd–Chiari syndrome in the absence of severe liver dysfunction. We discuss the management of a primigravida with Budd–Chiari syndrome and persistent hepatopulmonary syndrome post liver transplantation. A literature review revealed only one report of a successful pregnancy in association with hepatopulmonary syndrome. We discuss its recognition in patients with liver disease and anaesthetic considerations in its presence.