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Preemptive Venoarterial Extracorporeal Membrane Oxygenation for Liver Transplantation—Judicious Candidate Selection

Portopulmonary hypertension is a relatively common pathologic condition in patients with end-stage liver disease. Traditionally, severe pulmonary hypertension is regarded as a contraindication to liver transplantation (LT) due to a high perioperative mortality rate. Recently, extracorporeal membrane...

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Autores principales: Lee, Jennifer, Allen, Wesley L., Scott, Courtney L., Aniskevich, Stephen, Pai, Sher-Lu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10419537/
https://www.ncbi.nlm.nih.gov/pubmed/37568367
http://dx.doi.org/10.3390/jcm12154965
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author Lee, Jennifer
Allen, Wesley L.
Scott, Courtney L.
Aniskevich, Stephen
Pai, Sher-Lu
author_facet Lee, Jennifer
Allen, Wesley L.
Scott, Courtney L.
Aniskevich, Stephen
Pai, Sher-Lu
author_sort Lee, Jennifer
collection PubMed
description Portopulmonary hypertension is a relatively common pathologic condition in patients with end-stage liver disease. Traditionally, severe pulmonary hypertension is regarded as a contraindication to liver transplantation (LT) due to a high perioperative mortality rate. Recently, extracorporeal membrane oxygenation (ECMO) has been utilized for intraoperative management of LT. As venoarterial (VA) ECMO may benefit certain high-risk LT patients by reducing the ventricular workload by the equivalent of the programmed flow rate, its usage requires multidisciplinary planning with considerations of the associated complications. We highlighted two cases at our single-center institution as examples of high-risk pulmonary hypertension patients undergoing LT on planned VA ECMO. These patients both survived the intraoperative period; however, they had drastically different postoperative outcomes, generating discussions on the importance of judicious patient selection. Since ECMO has removed the barrier of intraoperative survivability, the patient selection process may need to put weight on the patient’s potential for postoperative recovery and rehabilitation. Considerations on LT recipients undergoing preemptive ECMO need to expand from the ability of the patients to withstand the demands of the surgery during the immediate perioperative period to the long-term postoperative recovery course.
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spelling pubmed-104195372023-08-12 Preemptive Venoarterial Extracorporeal Membrane Oxygenation for Liver Transplantation—Judicious Candidate Selection Lee, Jennifer Allen, Wesley L. Scott, Courtney L. Aniskevich, Stephen Pai, Sher-Lu J Clin Med Case Report Portopulmonary hypertension is a relatively common pathologic condition in patients with end-stage liver disease. Traditionally, severe pulmonary hypertension is regarded as a contraindication to liver transplantation (LT) due to a high perioperative mortality rate. Recently, extracorporeal membrane oxygenation (ECMO) has been utilized for intraoperative management of LT. As venoarterial (VA) ECMO may benefit certain high-risk LT patients by reducing the ventricular workload by the equivalent of the programmed flow rate, its usage requires multidisciplinary planning with considerations of the associated complications. We highlighted two cases at our single-center institution as examples of high-risk pulmonary hypertension patients undergoing LT on planned VA ECMO. These patients both survived the intraoperative period; however, they had drastically different postoperative outcomes, generating discussions on the importance of judicious patient selection. Since ECMO has removed the barrier of intraoperative survivability, the patient selection process may need to put weight on the patient’s potential for postoperative recovery and rehabilitation. Considerations on LT recipients undergoing preemptive ECMO need to expand from the ability of the patients to withstand the demands of the surgery during the immediate perioperative period to the long-term postoperative recovery course. MDPI 2023-07-28 /pmc/articles/PMC10419537/ /pubmed/37568367 http://dx.doi.org/10.3390/jcm12154965 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Lee, Jennifer
Allen, Wesley L.
Scott, Courtney L.
Aniskevich, Stephen
Pai, Sher-Lu
Preemptive Venoarterial Extracorporeal Membrane Oxygenation for Liver Transplantation—Judicious Candidate Selection
title Preemptive Venoarterial Extracorporeal Membrane Oxygenation for Liver Transplantation—Judicious Candidate Selection
title_full Preemptive Venoarterial Extracorporeal Membrane Oxygenation for Liver Transplantation—Judicious Candidate Selection
title_fullStr Preemptive Venoarterial Extracorporeal Membrane Oxygenation for Liver Transplantation—Judicious Candidate Selection
title_full_unstemmed Preemptive Venoarterial Extracorporeal Membrane Oxygenation for Liver Transplantation—Judicious Candidate Selection
title_short Preemptive Venoarterial Extracorporeal Membrane Oxygenation for Liver Transplantation—Judicious Candidate Selection
title_sort preemptive venoarterial extracorporeal membrane oxygenation for liver transplantation—judicious candidate selection
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10419537/
https://www.ncbi.nlm.nih.gov/pubmed/37568367
http://dx.doi.org/10.3390/jcm12154965
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