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Pachisia AV, Govil D, Jagadeesh KN, Patel SJ, Harne R, Pal D, Tyagi P, Pattajoshi S, Brar K, Patel P, Zatakiya R. Extracorporeal therapies for post-liver transplant recipient: The road less traveled. World J Transplant 2025; 15:101975. [DOI: 10.5500/wjt.v15.i3.101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 01/25/2025] [Accepted: 02/17/2025] [Indexed: 04/18/2025] Open
Abstract
Extracorporeal therapies have a definite role in patients with acute liver failure, acute on-chronic liver failure, and progressive chronic liver disease. They act as a bridge-to-transplant in these patients. With the increasing success of liver transplantation, the immediate postoperative complication spectrum continues to expand. Extracorporeal therapies can play an important role in managing these complications. However, the literature on extracorporeal therapies in the post-liver transplant period is limited. This review article discussed various extracorporeal therapies that are still evolving or marred by limited evidence but can improve patient outcomes. These extracorporeal therapies can be divided into two subgroups: (1) Therapies for infective complications. Endotoxin and cytokine adsorption columns; and (2) Therapies for noninfective complications like small for size syndrome, primary allograft nonfunction, early allograft dysfunction, hyperacute rejection, hepatopulmonary syndrome, etc. (plasma exchange, double plasma molecular adsorption, molecular adsorbent recirculation system, and extracorporeal membrane oxygenation, among others).
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Affiliation(s)
- Anant Vikram Pachisia
- Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram 122001, Haryana, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram 122001, Haryana, India
| | - KN Jagadeesh
- Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram 122001, Haryana, India
| | - Sweta J Patel
- Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram 122001, Haryana, India
| | - Rahul Harne
- Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram 122001, Haryana, India
| | - Divya Pal
- Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram 122001, Haryana, India
| | - Pooja Tyagi
- Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram 122001, Haryana, India
| | - Swagat Pattajoshi
- Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram 122001, Haryana, India
| | - Keerti Brar
- Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram 122001, Haryana, India
| | - Parimal Patel
- Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram 122001, Haryana, India
| | - Ronak Zatakiya
- Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram 122001, Haryana, India
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Radosevich M, Anderson A, Teixeira M, Diwan T, Heimbach J, Taner T, Spencer P, Diaz Soto J, Reynolds A, Neff A, Krowka M, Bohman J. Practical Considerations for Extracorporeal Membrane Oxygenation Use During Orthotopic Liver Transplantation. J Cardiothorac Vasc Anesth 2025; 39:803-812. [PMID: 39668049 DOI: 10.1053/j.jvca.2024.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 10/28/2024] [Accepted: 11/20/2024] [Indexed: 12/14/2024]
Abstract
Patients undergoing liver transplantation infrequently require extracorporeal membrane oxygenation (ECMO) support. However, when ECMO is required in the peritransplant period, several key considerations are required to maximize the efficacy of its support and minimize the risks of complications. This review seeks to briefly summarize the existing data supporting the use of ECMO in liver transplant patients and offers expert technical and practical advice from the authors' high-volume liver transplant center and ECMO program.
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Affiliation(s)
- Misty Radosevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Alexandra Anderson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Miguel Teixeira
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ty Diwan
- Department of Transplant Surgery, Mayo Clinic, Rochester, MN
| | - Julie Heimbach
- Department of Transplant Surgery, Mayo Clinic, Rochester, MN
| | - Timucin Taner
- Department of Transplant Surgery, Mayo Clinic, Rochester, MN
| | - Philip Spencer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Juan Diaz Soto
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Alex Reynolds
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Alexis Neff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Michael Krowka
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - John Bohman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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3
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Patel S, Gutmann C, Loveridge R, Pirani T, Willars C, Vercueil A, Angelova-Chee M, Aluvihare V, Heneghan M, Menon K, Heaton N, Bernal W, McPhail M, Gelandt E, Morgan L, Whitehorne M, Wendon J, Auzinger G. Perioperative extracorporeal membrane oxygenation in liver transplantation-bridge to transplantation, intraoperative salvage, and postoperative support: outcomes and predictors for survival in a large-volume liver transplant center. Am J Transplant 2025; 25:396-405. [PMID: 39182613 DOI: 10.1016/j.ajt.2024.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024]
Abstract
Data on perioperative extracorporeal membrane oxygenation (ECMO) in liver transplantation (LT) are scarce. ECMO has been used preoperatively, intraoperatively, and postoperatively for a variety of indications at our center. This retrospective, single-center study of ECMO use peri-LT aimed to describe predictors for successful outcome in this highly select cohort of patients. Demographics, support method, and indication for LT were compared between survivors and nonsurvivors. Twenty-nine patients received venovenous (V-V; n = 20), venoarterial (V-A; n = 8), and venoarteriovenous (n = 1) ECMO. Twelve (41.4%) patients were bridged to emergency LT for acute liver failure, and emergency redo LT. Four (13.3%) patients required intraoperative V-A ECMO salvage, 2 necessitating extracorporeal cardiopulmonary resuscitation. Thirteen (43.3%) patients required ECMO support after LT: V-V ECMO (n = 9); V-A ECMO (n = 1); and extracorporeal cardiopulmonary resuscitation (n = 3) between postoperative days 2 to 30. Overall, 19 patients (65.5%) were successfully weaned off ECMO; 15 (51.7%) survived to intensive care unit discharge. All patients who underwent intraoperative salvage ECMO and all who were bridged to emergency redo LT died. Peri-LT ECMO is feasible. Post-LT ECMO outcomes are encouraging, in particular for V-V ECMO. Intraoperative ECMO salvage, uncontrolled sepsis, and graft failure are associated with poor outcomes.
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Affiliation(s)
- Sameer Patel
- Liver Intensive Care, General Intensive Care & ECMO, Liver Intensive Therapy Unit, King's College Hospital, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, United Kingdom.
| | - Clemens Gutmann
- Faculty of Life Sciences and Medicine, King's College London, United Kingdom; Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Robert Loveridge
- Liver Intensive Care, General Intensive Care & ECMO, Liver Intensive Therapy Unit, King's College Hospital, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, United Kingdom
| | - Tasneem Pirani
- Liver Intensive Care, General Intensive Care & ECMO, Liver Intensive Therapy Unit, King's College Hospital, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, United Kingdom
| | - Chris Willars
- Liver Intensive Care, General Intensive Care & ECMO, Liver Intensive Therapy Unit, King's College Hospital, London, United Kingdom
| | - Andre Vercueil
- Critical Care & ECMO, Department of Critical Care, King's College Hospital, London, United Kingdom
| | - Milena Angelova-Chee
- Critical Care & ECMO, Department of Critical Care, King's College Hospital, London, United Kingdom
| | - Varuna Aluvihare
- Transplant Hepatology, Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Michael Heneghan
- Transplant Hepatology, Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Krishna Menon
- Liver Transplant Surgery, Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Nigel Heaton
- Liver Transplant Surgery, Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - William Bernal
- Faculty of Life Sciences and Medicine, King's College London, United Kingdom; Liver Intensive Care, Liver Intensive Therapy Unit, King's College Hospital, London, United Kingdom
| | - Mark McPhail
- Faculty of Life Sciences and Medicine, King's College London, United Kingdom; Liver Intensive Care, Liver Intensive Therapy Unit, King's College Hospital, London, United Kingdom
| | - Elton Gelandt
- Liver Intensive Therapy Unit, King's College Hospital, London, United Kingdom
| | - Lisa Morgan
- Liver Intensive Therapy Unit, King's College Hospital, London, United Kingdom
| | | | - Julia Wendon
- Faculty of Life Sciences and Medicine, King's College London, United Kingdom; Liver Intensive Care, Liver Intensive Therapy Unit, King's College Hospital, London, United Kingdom
| | - Georg Auzinger
- Liver Intensive Care, General Intensive Care & ECMO, Liver Intensive Therapy Unit, King's College Hospital, London, United Kingdom; Critical Care, Anesthesia & Pain Institute, Cleveland Clinic London, London, United Kingdom
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Barrueco-Francioni JE, Martínez-González MC, Martínez-Carmona JF, Benítez-Moreno MP, Aragón-González C, Herrera-Gutiérrez ME. ECMO in severe hypoxemia post liver transplant for hepatopulmonary syndrome. Int J Artif Organs 2024; 47:858-861. [PMID: 39221571 DOI: 10.1177/03913988241274252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Hepatopulmonary syndrome (HPS) poses a significant challenge in liver transplant patients, affecting between 10% and 30% of candidates. Historically, HPS was considered a contraindication for liver transplantation due to its association with high mortality rates. However, recent studies have shown improvements in pulmonary function post-transplant, leading to the inclusion of these patients as candidates. Despite this progress, approximately one-fifth of liver transplant recipients develop severe postoperative hypoxia, further complicating their clinical course and contributing to increased mortality. The management of post-transplant HPS involves various strategies, including extracorporeal membrane oxygenation (ECMO), although its use remains infrequently reported. Theoretical models suggest that oxygenation typically improves within 10 days post-transplant, while resolution of HPS may take 6-12 months, making ECMO an attractive possibility as a bridge to recovery in this population. We present a case were ECMO was used in this context.
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Affiliation(s)
- Jesús Emilio Barrueco-Francioni
- Unidad de Cuidados Intensivos, Sección de Trasplantes y Cuidados Postoperatorios, Hospital Regional Universitario de Málaga, Malaga, Spain
- Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain
| | - María Carmen Martínez-González
- Unidad de Cuidados Intensivos, Sección de Trasplantes y Cuidados Postoperatorios, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Juan Francisco Martínez-Carmona
- Unidad de Cuidados Intensivos, Sección de Trasplantes y Cuidados Postoperatorios, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - María Palma Benítez-Moreno
- Unidad de Cuidados Intensivos, Sección de Trasplantes y Cuidados Postoperatorios, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Cesar Aragón-González
- Unidad de Cuidados Intensivos, Sección de Trasplantes y Cuidados Postoperatorios, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Manuel Enrique Herrera-Gutiérrez
- Unidad de Cuidados Intensivos, Sección de Trasplantes y Cuidados Postoperatorios, Hospital Regional Universitario de Málaga, Malaga, Spain
- Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain
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Lyu H, Yi X, Zou Y, Lu P, Li L, Liu J, Chen S, Wei X, Yang Y, Yi H. Inhaled nitric oxide as a salvage therapy for refractory hypoxemia in the post-transplantation period of hepatopulmonary syndrome: An explorative report of three cases. LIVER RESEARCH 2024; 8:188-192. [PMID: 39957752 PMCID: PMC11771250 DOI: 10.1016/j.livres.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/18/2024] [Accepted: 09/10/2024] [Indexed: 02/18/2025]
Abstract
Liver transplantation (LT) is the only effective treatment for hepatopulmonary syndrome (HPS). Moreover, perioperative refractory hypoxemia (pRH) is a prevalent life-threatening condition and has extremely limited treatment options. Here, we report three patients with HPS who experienced pRH after LT and were consecutively treated with different salvage therapies, ephedrine inhalation, intravenous use of methylene blue with nitric oxide (NO) inhalation, and NO inhalation alone. The results showed that unresolved severe hypoxia may induce fatal morbidity such as early biliary leakage and acute kidney injury. Early initiation of NO inhalation, rather than ephedrine, can significantly improve oxygenation in patients with pRH and may help prevent hypoxia-related complications. Therefore, based on the response to these exploratory salvage treatments, we further demonstrate the unique ventilation-perfusion mismatch pathophysiology in specific lung regions during pRH in HPS. We propose that early inhalation of NO is an important treatment option to rescue severe hypoxia in patients with HPS during the perioperative period of LT.
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Affiliation(s)
- Haijin Lyu
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaomeng Yi
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yunshan Zou
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Pinglan Lu
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lijuan Li
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jianrong Liu
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Senbiao Chen
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xuxia Wei
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yang Yang
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, China
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Huimin Yi
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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6
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Bommena S, Fallon MB. Pulmonary Complications of Portal Hypertension. Clin Liver Dis 2024; 28:467-482. [PMID: 38945638 DOI: 10.1016/j.cld.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Portopulmonary hypertension (POPH), hepatopulmonary syndrome, and hepatic hydrothorax constitute significant complications of portal hypertension, with important implications for management and liver transplantation (LT) candidacy. POPH is characterized by obstruction and remodeling of the pulmonary resistance arterial bed. Hepatopulmonary syndrome is the most common pulmonary vascular disorder, characterized by intrapulmonary vascular dilatations causing impaired gas exchange. LT may improve prognosis in select patients with POPH. LT is the only effective treatment of hepatopulmonary syndrome. Hepatic hydrothorax is defined as transudative pleural fluid accumulation that is not explained by primary cardiopulmonary or pleural disease. LT is the definitive cure for hepatic hydrothorax.
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Affiliation(s)
- Shoma Bommena
- Department of Internal Medicine, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ, USA
| | - Michael B Fallon
- Department of Internal Medicine, University of Arizona College of Medicine-Phoenix, 475 North 5th Street, Phoenix, AZ 85004, USA.
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Sánchez Pérez B, Pérez Reyes M, Aranda Narvaez J, Santoyo Villalba J, Perez Daga JA, Sanchez-Gonzalez C, Santoyo-Santoyo J. New therapeutic strategy with extracorporeal membrane oxygenation for refractory hepatopulmonary syndrome after liver transplant: A case report. World J Transplant 2024; 14:89223. [PMID: 38576766 PMCID: PMC10989480 DOI: 10.5500/wjt.v14.i1.89223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/24/2023] [Accepted: 12/22/2023] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Due to the lack of published literature about treatment of refractory hepatopulmonary syndrome (HPS) after liver transplant (LT), this case adds information and experience on this issue along with a treatment with positive outcomes. HPS is a complication of end-stage liver disease, with a 10%-30% incidence in cirrhotic patients. LT can reverse the physiopathology of this process and restore normal oxygenation. However, in some cases, refractory hypoxemia persists, and extracorporeal membrane oxygenation (ECMO) can be used as a rescue therapy with good results. CASE SUMMARY A 59-year-old patient with alcohol-related liver cirrhosis and portal hypertension was included in the LT waiting list for HPS. He had good liver function (Model for End-Stage Liver Disease score 12, Child-Pugh class B7). He had pulmonary fibrosis and a mild restrictive respiratory pattern with a basal oxygen saturation of 82%. The macroaggregated albumin test result was > 30. Spirometry demon strated a forced expiratory volume in one second (FEV1) of 78%, forced vital capacity (FVC) of 74%, FEV1/FVC ratio of 81%, diffusion capacity for carbon monoxide of 42%, and carbon monoxide transfer coefficient of 57%. He required domiciliary oxygen at 2 L/min (16 h/d). The patient was admitted to the intensive care unit (ICU) and extubated in the first 24 h, needing high-flow therapy and non-invasive ventilation and inhaled nitric oxide afterwards. Reintubation was needed after 72 h. Due to the non-response to supportive therapies, installation of ECMO was decided with progressive recovery after 9 d. Extubation was possible on the tenth day, maintaining a high-flow nasal cannula and de-escalating to conventional oxygen therapy after 48 h. He was discharged from ICU on postoperative day (POD) 20 with a 90%-92% oxygen saturation. Steroid recycling was needed twice for acute rejection. The patient was discharged from hospital on POD 27 with no symptoms, with an 89%-90% oxygen saturation. CONCLUSION Due to the favorable results observed, ECMO could become the central axis of treatment of HPS and refractory hypoxemia after LT.
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Affiliation(s)
- Belinda Sánchez Pérez
- Hepatobiliary and Trasplantation Unit, General and Digestive Surgery Department, University Regional Hospital, Malaga 29010, Spain
| | - María Pérez Reyes
- Hepatobiliary and Trasplantation Unit, General and Digestive Surgery Department, University Regional Hospital, Malaga 29010, Spain
| | - Jose Aranda Narvaez
- Hepatobiliary and Trasplantation Unit, General and Digestive Surgery Department, University Regional Hospital, Malaga 29010, Spain
| | - Julio Santoyo Villalba
- Hepatobiliary and Trasplantation Unit, General and Digestive Surgery Department, University Regional Hospital, Malaga 29010, Spain
| | - Jose Antonio Perez Daga
- Hepatobiliary and Trasplantation Unit, General and Digestive Surgery Department, University Regional Hospital, Malaga 29010, Spain
| | - Claudia Sanchez-Gonzalez
- Department of General and Digestive Surgery, Regional University Hospital of Malaga, Malaga 29010, Spain
| | - Julio Santoyo-Santoyo
- Hepatobiliary and Trasplantation Unit, General and Digestive Surgery Department, University Regional Hospital, Malaga 29010, Spain
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8
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Qiu Y, Hilmi I. The applications of ECMO in liver transplant recipients. Transplant Rev (Orlando) 2024; 38:100816. [PMID: 38104398 DOI: 10.1016/j.trre.2023.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/23/2023] [Accepted: 12/03/2023] [Indexed: 12/19/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) has emerged as a vital instrument for sustaining respiratory and cardiac functions when traditional methods have failed. Its function in managing acute pulmonary and cardiac challenges during liver transplantation (LT) has expanded significantly. While ECMO was initially viewed as a rescue strategy for acute intraoperative or posttransplant complications, its application now also encompasses the pretransplant stage of LT. Our review aims to thoroughly summarize both research and specific cases where ECMO has been utilized across pre- and perioperative phases in liver transplant recipients. By assessing the published literature, we discuss specific indications, the types of ECMO employed, their outcomes, and the unique challenges of applying ECMO during LT. In particular, the pretransplant use of ECMO is increasing, and its prudent introduction prior to LT, supported by meticulous planning, has the potential to optimize patient outcomes. It is challenging to manage liver transplant patients on ECMO. More research and experience are needed to refine the techniques and improve patient outcomes. Furthermore, decision-making must be tailored to each patient's unique circumstances, and a clear, practical, and well-defined plan for subsequent steps is essential.
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Affiliation(s)
- Yue Qiu
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Department of Anesthesiology and Perioperative Medicine Education Office, Liliane S. Kaufmann Building, 3471 Fifth AVE, Suite 402, Pittsburgh, PA 15213, USA.
| | - Ibtesam Hilmi
- Anesthesiology and Perioperative Medicine, Clinical and Translational Science Institute, University of Pittsburgh, School of Medicine, Montefiore Anesthesiology Office 200 Lothrop St, Pittsburgh, PA 15213, USA.
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9
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Qiu Y, Hilmi I. The applications of ECMO in liver transplant recipients. Transplant Rev (Orlando) 2024; 38:100816. [DOI: https:/doi.org/10.1016/j.trre.2023.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
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10
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Nolasco L, Igwe D, Smith NK, Sakai T. Abdominal Organ Transplantation: Noteworthy Literature in 2022. Semin Cardiothorac Vasc Anesth 2023; 27:97-113. [PMID: 37037789 DOI: 10.1177/10892532231169075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
This review highlights noteworthy literature published in 2022 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We begin by exploring the impacts that the COVID-19 pandemic has had across the field of abdominal organ transplantation, including the successful use of grafts procured from COVID-19-infected donors. In pancreatic transplantation, we highlight several studies on dexmedetomidine and ischemia-reperfusion injury, equity in transplantation, and medical management, as well as studies comparing pancreatic transplantation to islet cell transplantation. In our section on intestinal transplantation, we explore donor selection. Kidney transplantation topics include cardiovascular risk management, obesity, and intraoperative management, including fluid resuscitation, dexmedetomidine, and sugammadex. The liver transplantation section focuses on clinical trials, systematic reviews, and meta-analyses published in 2022 and covers a wide range of topics, including machine perfusion, cardiovascular issues, renal issues, and coagulation/transfusion.
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Affiliation(s)
- Lyle Nolasco
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Divya Igwe
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Natalie K Smith
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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11
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Laici C, Bianchini A, Miglionico N, Bambagiotti N, Vitale G, Fallani G, Ravaioli M, Siniscalchi A. Planned Extracorporeal Life Support Employment during Liver Transplantation: The Potential of ECMO and CRRT as Preventive Therapies-Case Reports and Literature Review. J Clin Med 2023; 12:jcm12031239. [PMID: 36769889 PMCID: PMC9953574 DOI: 10.3390/jcm12031239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
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.
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Affiliation(s)
- Cristiana Laici
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Amedeo Bianchini
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Noemi Miglionico
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
| | - Niccolò Bambagiotti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
| | - Giovanni Vitale
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Correspondence:
| | - Guido Fallani
- Hepatobiliary and Transplant Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Matteo Ravaioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
- Hepatobiliary and Transplant Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Antonio Siniscalchi
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Wu HHL, Athwal VS, Kalra PA, Chinnadurai R. COVID-19 and hepatorenal syndrome. World J Gastroenterol 2022; 28:5666-5678. [PMID: 36338894 PMCID: PMC9627428 DOI: 10.3748/wjg.v28.i39.5666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/21/2022] [Accepted: 10/02/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly infectious disease which emerged into a global pandemic. Although it primarily causes respiratory symptoms for affected patients, COVID-19 was shown to have multi-organ manifestations. Elevated liver enzymes appear to be commonly observed during the course of COVID-19, and there have been numerous reports of liver injury secondary to COVID-19 infection. It has been established that patients with pre-existing chronic liver disease (CLD) are more likely to have poorer outcomes following COVID-19 infection compared to those without CLD. Co-morbidities such as diabetes, hypertension, obesity, cardiovascular and chronic kidney disease frequently co-exist in individuals living with CLD, and a substantial population may also live with some degree of frailty. The mechanisms of how COVID-19 induces liver injury have been postulated. Hepatorenal syndrome (HRS) is the occurrence of kidney dysfunction in patients with severe CLD/fulminant liver failure in the absence of another identifiable cause, and is usually a marker of severe decompensated liver disease. Select reports of HRS following acute COVID-19 infection have been presented, although the risk factors and pathophysiological mechanisms leading to HRS in COVID-19 infection or following COVID-19 treatment remain largely unestablished due to the relative lack and novelty of published data. Evidence discussing the management of HRS in high-dependency care and intensive care contexts is only emerging. In this article, we provide an overview on the speculative pathophysiological mechanisms of COVID-19 induced HRS and propose strategies for clinical diagnosis and management to optimize outcomes in this scenario.
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Affiliation(s)
- Henry H L Wu
- Renal Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney 2065, New South Wales, Australia
| | - Varinder S Athwal
- Faculty of Biology, Medicine & Health (Division of Diabetes, Metabolism & Gastroenterology), The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Philip A Kalra
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, United Kingdom
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, United Kingdom
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Raevens S, Boret M, Fallon MB. Hepatopulmonary syndrome. JHEP REPORTS : INNOVATION IN HEPATOLOGY 2022; 4:100527. [PMID: 36035361 PMCID: PMC9403489 DOI: 10.1016/j.jhepr.2022.100527] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
Hepatopulmonary syndrome (HPS) is a pulmonary vascular complication of liver disease, which adversely affects prognosis. The disease is characterised by intrapulmonary vascular dilatations and shunts, resulting in impaired gas exchange. A complex interaction between the liver, the gut and the lungs, predominately impacting pulmonary endothelial cells, immune cells and respiratory epithelial cells, is responsible for the development of typical pulmonary alterations seen in HPS. Liver transplantation is the only therapeutic option and generally reverses HPS. Since the implementation of the model for end-stage liver disease (MELD) standard exception policy, outcomes in patients with HPS have been significantly better than they were in the pre-MELD era. This review summarises current knowledge and highlights what’s new regarding the diagnosis and management of HPS, and our understanding of pathogenesis based on experimental models and translational studies.
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