Use of L-Arginine for inhaled Nitric Oxide (iNO) dependent  hepatopulmonary syndrome (HPS) Post-Liver Transplant

Authors

Mohnish Kataria1, Abhinav Rastogi2 , Sajaad Manzoor3 , Himanshu Tanwar2 , Sivaji Patibandla2 , Vishal V Singh4

Hepatopulmonary syndrome, liver transplantation, L-Arginine.

Hepatopulmonary syndrome (HPS) is one of the recognised complications of liver cirrhosis which warrants

urgent liver transplantation. We report a case of 7 year old girl who underwent orthotopic liver transplantation

(OLT) for severe HPS. Post transplantation the patient had a stormy respiratory course and became severely

hypoxemic. She was started on inhaled NO and showed a good response. However, the patient then became

NO dependent and multiple attempts to wean iNO failed albeit minimal ventilatory requirements. Following

IV L-Arginine infusion, iNO could be weaned within 6 hours without recurrence of hypoxemia. L-Arginine

infusion should be considered as a treatment option when facing difficulties to wean iNO in an otherwise

well responding patient.