Applications and Outcomes of Extracorporeal Life Support Use in Adult Liver Transplantation: A Case Series and Review of Literature

Park, Jeieung; Lin, Michael; Wray, Christopher; Kaldas, Fady M.; Benharash, Peyman; Gudzenko, Vadim

doi:10.1097/mat.0000000000001562

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…Four of these patients could not be weaned from ECMO and expired. 7 These results suggest that—in a scenario in which the donor organ has not yet been implanted—reallocation of the organ should be strongly considered and VA-ECMO during the transplant should be reserved only for potentially reversible conditions occurring in the neohepatic or postoperative phase of LT with a functioning graft.…”

Section: Discussionmentioning

confidence: 99%

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VA-ECMO Cardiac Support During Liver Transplant: A Case Report

et al. 2023

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Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for cardiovascular collapse during and after liver transplantation (LT). According to the most recent guidelines, patients with severe cardiomyopathy are excluded from LT because of high-mortality risk during surgery. Intraoperative ECMO support could give these patients the opportunity to undergo LT by reducing the risk of heart failure and reperfusion syndrome. In this case report, we present a case of venoarterial ECMO (VA-ECMO) support started before LT surgery in a patient with severe pulmonary hypertension, mitral valve steno-insufficiency, and right heart dysfunction. The presence of severe heart disease would have contraindicated LT, but simultaneous liver cirrhosis contraindicated mitral valve surgery, leaving the patient locked in a "Catch-22" state. The best solution was to perform LT with VA-ECMO support before, during, and after the surgery to reduce cardiac load and possible heart failure. LT was performed with good hemodynamic stability and the patient was successfully weaned from ECMO a few hours after surgery. At the 6 month follow-up, normal liver and kidney functions were recorded as well as an overall improvement of heart function; the patient successfully underwent mitral valve replacement and tricuspid annuloplasty 10 months after transplant and is now in good condition.

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Section: Discussionmentioning

confidence: 99%

“…Recently, Park et al . 7 report the use of VA-ECMO during LT in nine patients to manage acute cardiac failure caused by intracardiac thrombus, massive pulmonary embolism, stress-induced cardiomyopathy, or isolated right-ventricle failure. Five patients (55.6%) had a cardiac arrest and were placed on VA-ECMO under extracorporeal life-support.…”

Section: Discussionmentioning

confidence: 99%

VA-ECMO Cardiac Support During Liver Transplant: A Case Report

et al. 2023

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“…Some studies have suggested that prompt ECMO initiation may benefit graft survival. 4,13 More research is needed to determine the optimal timing of ECMO initiation in children after liver transplant. The elevated mortality in the ECPR group in our cohort might be attributed to the fact that the patients undergoing ECPR might constitute a specific group of children.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation After Liver Transplant in Children: A Review of the ELSO Registry

Di Nardo,

Cousin,

Alunni-Fegatelli

et al. 2024

ASAIO Journal

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There are minimal data describing use of extracorporeal membrane oxygenation (ECMO) in pediatric patient after a liver transplantation (LT). This study aimed at describing ECMO run in this specific situation using the data from Extracorporeal Life Support Organization (ELSO) Registry between January 1, 2010, to December 31, 2022. We described patients’ characteristics at ECMO initiation, outcome and mortality risk factors. We identified 27 patients with a median age of 2.7 years (interquartile range (IQR) = 1.5–9.9). Main indication for ECMO support was respiratory (14/27 [52%]) followed by extracorporeal cardiopulmonary resuscitation (ECPR) (7/27 [26%]) and cardiac (6/27 [22%]). Overall in-hospital mortality was 63% (17/27). Mortality rate according to ECMO indications was 50% for both respiratory and cardiac failure and reached 100% for ECPR patients. Overall, nonsurvivors experienced significantly more complications under ECMO support (p = 0.007). Main on-ECMO complications were hemorrhagic (11/27 [41%]) and thrombotic (7/27 [26%]). No clinical or biologic factors was predictive of patients’ outcome. Our results suggest that ECMO support is a viable option for cardiac and respiratory indications after pediatric LT. Occurrence of complications while on ECMO are associated with unfavorable outcomes. The extremely high mortality rate in ECPR patients merits further research.

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“…Given the increased prevalence of severe cardiovascular comorbidities and increased incidence of higher-risk LT recipients, experience with extracorporeal life support (ECLS), including extracorporeal membrane oxygenation (ECMO), is increasingly reported in adult LT. Rark and associates conducted a comprehensive literature search for adult LT cases that involved perioperative ECLS for respiratory or cardiac failure. 67 They identified 35 cases of respiratory failure in LT patients requiring perioperative ECLS. Applications included a preoperative bridge to LT (n = 6) and postoperative rescue (n = 29), for which overall survival was 44%.…”

Section: Liver Transplantationmentioning

confidence: 99%

Abdominal Organ Transplantation: Noteworthy Literature in 2022

Nolasco

Igwe

Sakai

2023

Semin Cardiothorac Vasc Anesth

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This review highlights noteworthy literature published in 2022 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We begin by exploring the impacts that the COVID-19 pandemic has had across the field of abdominal organ transplantation, including the successful use of grafts procured from COVID-19-infected donors. In pancreatic transplantation, we highlight several studies on dexmedetomidine and ischemia-reperfusion injury, equity in transplantation, and medical management, as well as studies comparing pancreatic transplantation to islet cell transplantation. In our section on intestinal transplantation, we explore donor selection. Kidney transplantation topics include cardiovascular risk management, obesity, and intraoperative management, including fluid resuscitation, dexmedetomidine, and sugammadex. The liver transplantation section focuses on clinical trials, systematic reviews, and meta-analyses published in 2022 and covers a wide range of topics, including machine perfusion, cardiovascular issues, renal issues, and coagulation/transfusion.

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Applications and Outcomes of Extracorporeal Life Support Use in Adult Liver Transplantation: A Case Series and Review of Literature

Cited by 7 publications

References 30 publications

VA-ECMO Cardiac Support During Liver Transplant: A Case Report

VA-ECMO Cardiac Support During Liver Transplant: A Case Report

Extracorporeal Membrane Oxygenation After Liver Transplant in Children: A Review of the ELSO Registry

Abdominal Organ Transplantation: Noteworthy Literature in 2022

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