Utilization of extracorporeal membrane oxygenation for a severe cardiocirculatory dysfunction recipient in liver transplantation

Sun, Xu; Qiu, Wei Qiao; Chen, Yuguo; Lv, Guoyue; Fan, Zhongqi

doi:10.1097/md.0000000000012407

Cited by 13 publications

(14 citation statements)

References 18 publications

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“…The application of ECMO to patients during the liver transplantation perioperative period may help recipients with severe cardiac disease to maintain the heart function and alleviate the reperfusion syndrome; however, its use is limited out of concern of the need for anticoagulation [66]. ECMO has been mainly used as an intraoperative rescue option during liver transplantation [65].…”

Section: Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

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Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension

Kandil

2019

Current Opinion in Organ Transplantation

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Purpose of reviewLiver transplantation in patients with portopulmonary hypertension (POPH) is associated with increased perioperative risk. Important recent advances in the management of liver transplantation recipients with POPH are discussed. Recent findingsThe presence of POPH at the time of liver transplantation should not be a contraindication for liver transplantation, as POPH is common and may be related to volume overload and/or high cardiac output (CO). Available data suggest that patients with mild POPH (25-35 mmHg) can safely undergo liver transplantation surgery. In more severe cases, treatment of POPH with a combination of vasoactive drugs may lead to successful liver transplantation with normalization of POPH. The key to successful intraoperative anesthetic management is maintaining the right ventricular preload and avoiding right ventricular dysfunction. Techniques include diuresis, intraoperative hemodialysis, venovenous bypass, or extracorporeal membrane oxygenation. Apart from the surgical and anesthetic techniques used, factors that contribute to increased pulmonary vascular resistance have to be avoided and the continuation of the vasodilators into the intraoperative and postoperative periods is crucial.

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Section: Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

“…ECMO has been mainly used as an intraoperative rescue option during liver transplantation [65]. Prophylactic ECMO use as a measure to prevent cardiocirculatory failure has been successfully used in liver transplantation [66].…”

Section: Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension

Kandil

2019

Current Opinion in Organ Transplantation

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“…One patient with pulmonary hypertension due to severe mitral regurgitation was placed electively on VA-ECMO immediately before LT. 29 The patient was weaned from ECLS on POD no. 2 and survived to discharge.…”

Section: Resultsmentioning

confidence: 99%

“…12,13 Both underwent successful LT and survived to discharge; however, one patient developed an IVC thrombus one week after discharge and died. 12 One patient with pulmonary hypertension due to severe mitral regurgitation was placed electively on VA-ECMO immediately before LT. 29 The patient was weaned from ECLS on POD no. 2 and survived to discharge.…”

Section: Ecls For Cardiac Failure In Pretransplant Period As a Bridge...mentioning

confidence: 99%

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

et al. 2021

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The use of extracorporeal life support (ECLS) is increasingly reported in adult liver transplantation (LT). However, neither the role of ECLS in the perioperative setting for LT nor its outcomes has been well defined. We performed a retrospective chart review of all adult LT patients at our institution who received ECLS from 2004 to 2021. We also conducted a comprehensive literature search for adult LT cases that involved perioperative ECLS for respiratory or cardiac failure. Over the study period, 11 LT patients required ECLS at our institution, two for respiratory and nine for cardiac failure. Both patients with respiratory failure received ECLS as a bridge to LT and survived to discharge. Nine patients required ECLS for acute cardiac failure either intraoperatively or postoperatively, and two survived to discharge. In the literature, we identified 35 cases of respiratory failure in LT patients requiring perioperative ECLS. Applications included preoperative bridge to LT (n = 6) and postoperative rescue (n = 29), for which overall survival was 44%. We identified 31 cases of cardiac failure in LT patients requiring either ECLS or cardiopulmonary bypass for cardiac support or rescue for intraoperative or postoperative cardiac failure (n = 30). There is evidence for consideration of ECLS as a bridge to LT in patients with potentially reversible respiratory failure or as rescue therapy for respiratory failure in posttransplant patients. ECLS has a prohibitively high risk of futility in pretransplant patients with cardiac failure but may have a role in LT patients with a functioning graft and potentially reversible cardiac failure.

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“…The use of ECMO as a prophylactic measure was recently described in a high‐risk patient, 100 and may be an option, but needs further evaluation before it can be recommended universally. The largest review of ECMO use in the LT population, including 1,792 patients undergoing orthotopic liver transplantation, reported an overall survival rate of 38% 101 .…”

Section: Perioperative Management Of Heart Failurementioning

confidence: 99%

Acute heart failure after liver transplantation: A narrative review

Sharma

Sonny

Dalia

et al. 2020

Clinical Transplantation

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Acute heart failure (AHF) is present in a substantial proportion of patients after liver transplantation (LT), and is associated with significant morbidity and mortality. 1-4 The pretransplant hemodynamic changes (decreased systemic vascular resistance (SVR), poor ventricular response to stress and increased cardiac output) that occur in patients with end-stage liver disease (ESLD) coupled with the effects of pro-inflammatory cytokines released during reperfusion of the liver during transplantation have been implicated in both systolic and diastolic dysfunction, contributing to AHF. 5 Both ischemic and non-ischemic causes have been implicated. While ischemic heart disease, has well defined risk factors, and may be identified preoperatively, non-ischemic AHF, is a poorly understood entity and can occur in the absence of obvious risk factors. Standard preoperative workup including electrocardiogram (EKG), echocardiography at rest or on stress, or biomarkers has limitations in predicting this risk. Cirrhotic cardiomyopathy, iron overload cardiomyopathy, and stress-induced cardiomyopathy are some of the commonly implicated entities. Distinguishing one etiology from the other is difficult and multiple etiologies may coexist in the same patient. While early recognition of risk factors and diagnosis is difficult, once diagnosed, there are no clear-cut rules for candidacy of transplant in these patients and no guidelines exist to help optimize these patients prior to transplant. These patients are at a high-risk of cardiovascular collapse either during the intraoperative period or in the immediate postoperative period and approaches to mitigate these risks as

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Utilization of extracorporeal membrane oxygenation for a severe cardiocirculatory dysfunction recipient in liver transplantation

Cited by 13 publications

References 18 publications

Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension

Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension

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

Acute heart failure after liver transplantation: A narrative review

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