Postoperative Liver Failure Secondary to Hypoxic Hepatitis in Double Lung Transplantation: A Case Report

•Importance of adequate integral preoperative workup for lung transplantation, especially patients who present with altered liver enzymes.Use of mechanical assistance in the setting of lung transplantation and liver dysfunction, evidencing the lack of evidence for the association between ECMO´s implication in inflammatory states and its relationship with hypoxic hepatitis and liver dysfunction.•Report of hypoxic hepatitis on a double lung transplantation patient with idiopathic pulmonary fibrosis and history of Sjogren syndrome, with a unfavorable outcome in order to raise important questions about the decisions made along the transplantation process. Hypoxic hepatitis is a diagnosis of exclusion that should be suspected in patients with systemic hypoperfusion risk factors. It has a very high mortality, close to 50%. Although respiratory failure has been described as an etiologic factor for hypoxic hepatitis, cases of liver failure secondary to hypoxic hepatitis after lung transplantation have not been reported. Here we describe the case of a 54-year-old patient who underwent double lung transplantation with intraoperative ECMO and presented postoperative liver failure with a fatal outcome, despite adequate functioning of the lung graft. We describe the clinical presentation, risk factors, intra- and postoperative course, diagnosis, and the importance of pretransplant assessment, along with a review of the literature.