Extracorporeal Membrane Oxygenation and Severe Portopulmonary Hypertension following Liver Transplantation: Brief Report

Chan-Dominy, Amy; Rahiman, Sarfaraz; Anders, Marc; Butt, Warwick

doi:10.5301/ijao.5000410

Cited by 11 publications

(12 citation statements)

References 34 publications

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“…In case of refractory right ventricular failure on optimal medical management, extracorporeal life support can be considered, clinical experience being however very limited. 59,60 After the immediate postoperative period, a close attention should be paid on the evolution of pulmonary hypertension to optimize care. In case of PAH worsening during the critical first 6 months after LT, additional PAH therapy should be considered.…”

Section: Management Of Liver Transplantation Candidates With Pophmentioning

confidence: 99%

Portopulmonary Hypertension

Watherald

Sitbon

Savale

2017

Semin Respir Crit Care Med

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Portal hypertension may have major consequences on the pulmonary vasculature due to complex pathophysiological interactions between liver and lungs. Portopulmonary hypertension (PoPH) is characterized by the association of portal hypertension and pulmonary arterial hypertension (PAH). As progressive elevation of right ventricular afterload can lead to right heart failure, PoPH is a serious complication of portal hypertension, affecting functional status and prognosis of patients. Early detection by transthoracic echocardiography must be performed in symptomatic patients and in candidates for liver transplantation (LT). Right heart catheterization remains mandatory to confirm the diagnosis and exclude all other causes of elevated pulmonary pressures. The management of PoPH includes PAH-targeted therapies although few studies have evaluated these medications in this specific indication. The impact of LT on PoPH outcome remains complex and must be specified by future collaborative investigation. Although uncontrolled PoPH is associated with higher risk of postoperative right heart failure and death, stabilization, improvement, or normalization of pulmonary hemodynamics after LT seem to be achievable goals in selected patients with PoPH.

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Section: Management Of Liver Transplantation Candidates With Pophmentioning

confidence: 99%

Portopulmonary Hypertension

Watherald

Sitbon

Savale

2017

Semin Respir Crit Care Med

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“…This view has been corroborated by recent reports involving larger numbers of patients . However, as yet there are few reports concerning the use of ECMO for perioperative management in pediatric LT …”

Section: Introductionmentioning

confidence: 59%

“…This view has been corroborated by recent reports involving larger numbers of patients. 4,5 However, as yet there are few reports concerning the use of ECMO for perioperative management in pediatric LT. [6][7][8][9][10][11][12] We describe herein a 5-year-old girl with post-LT refractory septic shock who was successfully treated with VA ECMO. This is the first report of the use of VA ECMO in a post-LT patient with sepsis.…”

Section: Introductionmentioning

confidence: 99%

Successful venoarterial extracorporeal membrane oxygenation for postoperative septic shock in a child with liver transplantation: A case report

Abe

Ide

Nishimura

et al. 2017

Pediatric Transplantation

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Refractory septic shock after LT is a life-threatening complication. VA ECMO is used to treat refractory cardiorespiratory failure. We present herein the case of a 5-year-old girl with post-Kasai biliary atresia, who underwent a living donor LT and suffered refractory septic shock. VA ECMO was indicated due to progressive cardiac deterioration. After full recovery of her EF, she has been steadily improving and has shown good liver function and no neurological sequelae. This is the first report of successful VA ECMO in a post- LT patient with refractory septic shock.

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“…One report describes the use of VV ECMO to treat severe portopulmonary hypertension 5 days after OLT in a 7-yearold girl. (11) Sadly, she died 2 weeks later while being considered for lung transplantation for intractable pulmonary hypertension. It is likely that other similar patients exist and are underreported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation and pediatric liver transplantation, “a step too far?”: Results of a single‐center experience

et al. 2016

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Extracorporeal Membrane Oxygenation and Severe Portopulmonary Hypertension following Liver Transplantation: Brief Report

Abstract: ECMO resuscitation and support may be deployed as rescue therapy around the period of liver transplantation. We highlight the importance of patient selection and high risk of complications during ECMO therapy as a bridge to PoPH control.

Cited by 11 publications

References 34 publications

Portopulmonary Hypertension

Portopulmonary Hypertension

Successful venoarterial extracorporeal membrane oxygenation for postoperative septic shock in a child with liver transplantation: A case report

Extracorporeal membrane oxygenation and pediatric liver transplantation, “a step too far?”: Results of a single‐center experience

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