Utilization of extracorporeal membrane oxygenation for a severe cardiocirculatory dysfunction recipient in liver transplantation: A case report

Abstract

Rationale: Severe cardiac dysfunction or severe pulmonary hypertension is a contraindication of liver transplantation (LT). Extracorporeal membrane oxygenation (ECMO) is an advanced therapy for severe lung and/or cardiocirculatory dysfunction or failure. The application of ECMO to patients during the LT perioperative period may help recipients with severe cardiac disease to maintain the heart function and alleviate the reperfusion syndrome.

Patient concerns: A female liver recipient complained about weakness for 6 months.

Diagnoses: The patient was diagnosed as hepatitis B virus (HBV)-related hepatic cirrhosis (MELD 24, Child-Pugh C) with severe mitral regurgitation, severe tricuspid regurgitation, left atrium and left ventricle enlargement, cardiac insufficiency, pulmonary arterial hypertension, and hypoxemia.

Interventions: The patient underwent LT from a cardiac deceased donor. The surgery was completed by venoarterial ECMO. The femoral vessels cannulation was done after the dissection of the patient's liver and before the venous blocking. Venous cannula reached to the position below renal vein, while arterial cannula reached to common iliac artery. We regulated the ECMO index according to the patient's condition. The dosage of heparin was adjusted on the basis of the activated clotting time. Respiratory support, milrinone, furosemide, and mannitol were used to improve the circulation. The bleeding volume of surgery was 1200 mL. The cardiocirculatory function and other vital signs remained good in the perioperative period. In the first 24 hours after surgery, central venous pressure decreased from 17 to 7 cmH2O. Thirty hours after surgery, the ECMO was removed. Eighteen hours later, the recipient did not need respiratory support.

Outcomes: No complications of transplantation or ECMO were found.

Lessons: It is feasible to utilize ECMO as a cardiocirculatory function support in the LT. ECMO does not increase the risk of hemorrhage. ECMO can play an important role in ensuring the security of the liver recipients in the surgery and in the postoperative period.