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The Utility of ECMO After Liver Transplantation

Experience at a High-volume Transplant Center and Review of the Literature

Braun, Hillary J. MD1; Pulcrano, Marisa E. MD1; Weber, Daniel J. MD1; Padilla, Benjamin E. MD1; Ascher, Nancy L. MD, PhD1

doi: 10.1097/TP.0000000000002716

Background. Extracorporeal membrane oxygenation (ECMO) artificially supports respiratory and cardiac function when conventional techniques fail. ECMO has been described as a treatment modality for acute pulmonary and cardiac failure following orthotopic liver transplantation (OLT). Here, we present a series of adult OLT recipients placed on ECMO after transplantation for both respiratory and cardiac indications and review the literature on the role of ECMO in the setting of OLT.

Methods. For the patient series, we cross-referenced all patients who underwent OLT at our institution between 2007 and 2018 with the ECMO database of our institution and described these cases. For the literature review, we identified cases and series that described the use of ECMO after liver transplantation in adult recipients.

Results. A total of 1792 patients underwent OLT. Eight patients were placed on ECMO (0.4%), 5 men and 3 women aged 28 to 68 years (4 venovenous and 4 venoarterial). Three of (38%) 8 patients survived to discharge and are alive today. In the literature, we identified 3 series and 12 case reports of ECMO following OLT, with the majority of the literature derived from the Asian OLT experience.

Conclusions. ECMO following liver transplantation should be considered as a viable rescue strategy in patients with severe cardiopulmonary failure. ECMO is particularly effective if the cause of cardiopulmonary failure is recognized promptly and is thought to be transient. This is the largest series in the United States and demonstrates a 38% survival rate, which is comparable to other reports in the literature from Asia.

1 Department of Surgery, University of California, San Francisco, CA.

Received 25 October 2018. Revision received 28 February 2019.

Accepted 7 March 2019.

The authors declare no conflicts of interest.

H.J.B. and M.E.P. contributed to the research design, performance of research, writing, and reviewing of the article. D.W. contributed to writing and reviewing of the article. B.P. contributed to the writing and reviewing of the article. N.A. contributed to research design and writing and reviewing of the article. H.J.B. and M.E.P. contributed equally to this work.

Correspondence: Dr. Nancy L. Ascher, MD, PhD, Professor of Surgery Division of Transplant, University of California, San Francisco Box 0780, 505 Parnassus Ave, M884, San Francisco, CA 94117. (

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