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< Vol. 38 Issue 3 | Mar 2015 | pp. 117 - 172

Extracorporeal membrane oxygenation after liver transplantation in a patient with hepatopulmonary syndrome and an atrial septal defect

Extracorporeal membrane oxygenation after liver transplantation in a patient with hepatopulmonary syndrome and an atrial septal defect

Int J Artif Organs 2015; 38(3): 170 - 172

Article Type: SHORT COMMUNICATION

DOI:10.5301/ijao.5000399

Authors

Nirmal S. Sharma, Keith M. Wille, Enrique Diaz Guzman

Abstract

Introduction

Hepatopulmonary syndrome (HPS) is a rare complication of liver cirrhosis that may result in refractory hypoxemia even after liver transplantation. ECMO has been rarely used after liver transplantation or in patients with HPS.

 Methods

We present a patient with HPS who underwent liver transplantation and developed refractory hypoxemia requiring postoperative ECMO support at our institution. During our review of literature we found nine reports of ECMO use for cardiorespiratory failure after liver transplant in the past.

 Results

Our patient had persistent intrapulmonary shunting and developed severe respiratory failure after liver transplant. Additionally, the patient was found to have an atrial septal defect (ASD) and required percutaneous closure while receiving ECMO support. Literature review suggests that survival among these patients who were supported with ECMO after liver transplant was 50% and catastrophic bleeding complications were described in only one report.

 Conclusions

With careful selection of post-liver transplant patients and judicious management of anticoagulation, ECMO can be safely instituted in this cohort.

Article History

  • • Accepted on 30/01/2015
  • • Available online on 20/03/2015
  • • Published in print on 13/04/2015

Disclosures

Financial support: None.
Conflict of interest: None to declare.

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Authors

  • Sharma, Nirmal S. [PubMed] [Google Scholar]
  • Wille, Keith M. [PubMed] [Google Scholar]
  • Diaz Guzman, Enrique [PubMed] [Google Scholar] , * Corresponding Author ([email protected])

Affiliations

  • Division of Pulmonary & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama - USA

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