Introduction: Hepatopulmonary syndrome (HPS) is characterised by hypoxia and is associated with a worse prognosis in patients with cirrhosis. Liver transplantation is the only definitive treatment. We report our 10 year experience of live donor liver transplant in adult patients with HPS.

Methods: Seventeen patients with HPS (age ≥ 18 years) and cirrhosis who underwent LDLT during the period 2012 – 2022 were retrospectively analysed. HPS was defined as PaO2 < 80 mmHg in presence of demonstrable macro-aggregated albumin (MAA) scan shunt fraction >6%.

Results: The study group composed of 15 male and 2 female patients, mean age 51.05 ± 7.67 years. The most common presentations was dyspnoea, seen in 82.35% patients followed by ascites (76.47%) and gastrointestinal bleed (41.18%). Mean Child Pugh score was 10.52 ± 1.77, model for end-stage liver disease (MELD) score was 20.35 ± 7.38. One patient had very severe HPS (PaO2 <50 mmHg), four had severe HPS (PaO2 50 - 60 mmHg) and twelve had moderate HPS (PaO2 60 - 80 mmHg). The mean MAA shunt fraction was 24.05 ± 18.52% and mean PaO2 was 66.77 ± 10.63 mmHg. All patients underwent right lobe LDLT. The overall time to extubation was 1.23 ± 0.83 days and for ICU stay8.66 ± 0.55 days. Patients received oxygen for a median of 3 [2 – 5] days post-transplant. The main complications in post-LT course were sepsis and neurological, both seen in 3 patients each (17.64%). Overall survival at a median follow up of 54.5 [17 – 76] months was 82.35%.

Conclusion: LDLT in HPS is feasible and is associated with good outcomes.