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Patients with liver disease can have varied cardiac manifestations including pulmonary arteriovenous dilatation. The stress of surgery associated with catecholamine surges can also potentiate stress-related changes. We report management of hypoxemia in a patient who underwent liver transplantation. Although her preoperative oxygenation (SpO2 97%) measured 2 weeks earlier was normal, she manifested hypoxemia on the day of surgery and cardiovascular failure perioperatively. Postoperative investigations revealed a stress cardiomyopathy. The cause of persistent and refractory hypoxemia was uncertain in the context of normal preoperative tests. However, she responded immediately to inhaled nitric oxide, suggesting a correction of ventilation perfusion dynamics. We wish to highlight a possible role of nitric oxide in postoperative liver transplant patients with refractory hypoxemia of uncertain etiology.