Perioperative extracorporeal membrane oxygenation in liver transplantation-bridge to transplantation, intraoperative salvage and postoperative support outcomes and predictors for survival in a large-volume liver transplant center
No Thumbnail Available
Authors
Patel, Sameer
Gutmann, Clemens
Loveridge, Robert
Pirani, Tasneem
Willars, Chris
Vercueil, Andre
Angelova-Chee, Milena
Aluvihare, Varuna
Heneghan, Michael
Menon, Krishna
Check for full-text access
Issue Date
2025
Type
Article
Language
Keywords
Alternative Title
Abstract
Data on perioperative extracorporeal membrane oxygenation (ECMO) in liver transplantation (LT) are scarce. ECMO has been used preoperatively, intraoperatively, and postoperatively for a variety of indications at our center. This retrospective, single-center study of ECMO use peri-LT aimed to describe predictors for successful outcome in this highly select cohort of patients. Demographics, support method, and indication for LT were compared between survivors and nonsurvivors. Twenty-nine patients received venovenous (V-V; n = 20), venoarterial (V-A; n = 8), and venoarteriovenous (n = 1) ECMO. Twelve (41.4%) patients were bridged to emergency LT for acute liver failure, and emergency redo LT. Four (13.3%) patients required intraoperative V-A ECMO salvage, 2 necessitating extracorporeal cardiopulmonary resuscitation. Thirteen (43.3%) patients required ECMO support after LT: V-V ECMO (n = 9); V-A ECMO (n = 1); and extracorporeal cardiopulmonary resuscitation (n = 3) between postoperative days 2 to 30. Overall, 19 patients (65.5%) were successfully weaned off ECMO; 15 (51.7%) survived to intensive care unit discharge. All patients who underwent intraoperative salvage ECMO and all who were bridged to emergency redo LT died. Peri-LT ECMO is feasible. Post-LT ECMO outcomes are encouraging, in particular for V-V ECMO. Intraoperative ECMO salvage, uncontrolled sepsis, and graft failure are associated with poor outcomes.
Description
Citation
Publisher
License
Journal
American Journal of Transplantation
Volume
25
Issue
2