Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 3;12(3):1239.
doi: 10.3390/jcm12031239.

Planned Extracorporeal Life Support Employment during Liver Transplantation: The Potential of ECMO and CRRT as Preventive Therapies-Case Reports and Literature Review

Cristiana Laici  1 , Amedeo Bianchini  1 , Noemi Miglionico  2 , Niccolò Bambagiotti  2 , Giovanni Vitale  3 , Guido Fallani  4 , Matteo Ravaioli  2   4 , Antonio Siniscalchi  1
Affiliations

Planned Extracorporeal Life Support Employment during Liver Transplantation: The Potential of ECMO and CRRT as Preventive Therapies-Case Reports and Literature Review

Cristiana Laici et al. J Clin Med. .

Abstract

Liver Transplantation (LT) has become the gold standard treatment for End-Stage Liver Disease (ESLD). One of the main strategies to manage life-threatening complications, such as cardio-respiratory failure, is Extracorporeal Membrane Oxygenation (ECMO) in the peri-transplantation period, with different configurations of the technique and in combination with other extracorporeal care devices such as Continuous Renal Replacement Therapy (CRRT). This retrospective study includes three clinical cases of planned ECMO support strategies in LT and evaluates their application compared with current literature exploring PubMed/Medline. The three LT supported with ECMO and CRRT were performed at IRCCS Polyclinic S. Orsola-Malpighi, Bologna. All three cases of patients with compromised organ function analysed produced positive outcomes. The planned use of ECMO and CRRT support in peri-transplantation has allowed the patients to overcome contraindications and successfully undergo LT. In recent years, only a few reports have documented successful LT outcomes performed with intraoperative ECMO in critically ESLD patients. However, the management of LT with ECMO and/or CRRT assistance is an emerging challenge, with the need for more published evidence on this topic to guide treatment choices in patients with severe, acute and reversible respiratory and cardiovascular failure after LT.

Keywords: Continuous Renal Replacement Therapy; Veno-Arterial Extracorporeal Membrane Oxygenation; Veno-Venous Extracorporeal Membrane Oxygenation; liver transplant.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Selection process for references included. VV ECMO: Veno-Venous Extracorporeal Membrane Oxygenator; VA ECMO: Veno-Arterial Extracorporeal Membrane Oxygenator; CRRT: Continuous Renal Replacement Therapy; LT: Liver Transplantation.
Figure 2
Figure 2
Decision Flowchart in our cases. * WHO Group 2 encloses PAH due to left heart disease. Since PAH can often be a complication of certain left heart failures, such as valvular heart diseases and congenital defects, we classified case 3 as a probable group 2 PAH worsening from the cirrhotic status of the patient [8]. HPS: Hepato-Pulmonary Syndrome; PoPH: Porto-Pulmonary Hypertension; PAH: Pulmonary Arterial Hypertension; ECMO: Extracorporeal Membrane Oxygenator; VV ECMO: Veno-Venous Extracorporeal Membrane Oxygenator; VA ECMO: Veno-Arterial Extracorporeal Membrane Oxygenator; AKI: Acute Kidney Injury; EF: Ejection Fraction; LT: Liver Transplantation; WHO: Word Health Organization.
Figure 3
Figure 3
Graphic scheme of Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) and Continuous Veno-Venous Hemodiafiltration (CVVHD).
See this image and copyright information in PMC

References

    1. Caturegli G., Crane M.A., Etchill E., Giuliano K., Nguyen M., Philosophe B., Cho S.M., Wittstein I.S., Whitman G.J.R. Stress-induced (Takotsubo) cardiomyopathy after liver transplant rescued with venoarterial extracorporeal membrane oxygenation. ASAIO J. 2022;68:e66–e68. doi: 10.1097/MAT.0000000000001453. - DOI - PubMed
    1. Shimura K., Matsumoto S., Ide K., Baba C., Nakagawa S., Shoji K., Uchida H., Fukuda A., Sakamoto S., Kasahara M. Rescue venovenous extracorporeal membrane oxygenation for the deterioration of acute respiratory distress syndrome in pediatric liver transplantation. Pediatr. Transplant. 2022;26:e14305. doi: 10.1111/petr.14305. - DOI - PubMed
    1. Martucci G., Burgio G., Lullo F., Panarello G., Arcadipane A. Veno-arterial extracorporeal membrane oxygenation as an intraoperative rescue option in case of portopulmonary hypertension recognized during liver transplantation. Minerva Anestesiol. 2017;83:1336–1337. doi: 10.23736/S0375-9393.17.12224-8. - DOI - PubMed
    1. Wu W.K., Grogan W.M., Ziogas I.A., Patel Y.J., Bacchetta M., Alexopoulos S.P. Extracorporeal membrane oxygenation in patients with hepatopulmonary syndrome undergoing liver transplantation: A systematic review of the literature. Transplant. Rev. 2022;36:100693. doi: 10.1016/j.trre.2022.100693. - DOI - PubMed
    1. Sun X., Qiu W., Chen Y., Lv G., Fan Z. Utilization of extracorporeal membrane oxygenation for a severe cardiocirculatory dysfunction recipient in liver transplantation: A case report. Medicine. 2018;97:e12407. doi: 10.1097/MD.0000000000012407. - DOI - PMC - PubMed

LinkOut - more resources