Severe acute pulmonary edema during living related liver transplantation surgery

We report a case of severe intraoperative pulmonary edema during living related liver transplantation (LRLT) surgery. A 60-year-old woman with end-stage primary biliary cirrhosis underwent LRLT. After administration of several units of packed red blood cells and fresh frozen plasma, a gradual decline in oxygen saturation was observed. After an unexpectedly prolonged ahepatic phase, she developed severe pulmonary edema and critical hypoxemia. Further deterioration of hypoxemia was observed after reperfuion of the portal vein. We conclude that this severe pulmonary edema was caused by transfusion related acute lung injury, and prolonged ahepatic phase with reperfusion injury deteriorated the lung condition.