Severe hepatopulmonary syndrome with hypoxemia refractory to liver transplant: Recovery after 67 days of ECMO support

Hepatopulmonary syndrome (HPS) is a complication of end stage liver disease (ESLD) and is manifested by severe hypoxemia, which usually responds to liver transplantation (LT). As compared to patients undergoing LT for other etiologies, patients with HPS present an increased risk of postoperative mor...

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Bibliographic Details
Published in:International journal of artificial organs 2022-01, Vol.45 (1), p.121-123
Main Authors: Piltcher-da-Silva, Rodrigo, Chedid, Marcio Fernandes, Grezzana Filho, Tomaz Jesus Maria, Leipnitz, Ian, de Araújo, Alexandre, Gazzana, Marcelo Basso, Saueressig, Mauricio Guidi, Lorenzi, William, Cardoni, Mario Gurvitez, Bellaver, Priscila, Alvares-da-Silva, Mario Reis, Feier, Flavia Heinz, Chedid, Aljamir Duarte, Kruel, Cleber Rosito Pinto
Format: Article
Language:English
Subjects:
Adolescent
End Stage Liver Disease
Etiology
Extracorporeal Membrane Oxygenation
Hepatopulmonary Syndrome - diagnosis
Hepatopulmonary Syndrome - etiology
Hepatopulmonary Syndrome - therapy
Humans
Hypoxemia
Hypoxia - etiology
Hypoxia - therapy
Liver
Liver diseases
Liver transplantation
Liver Transplantation - adverse effects
Male
Morbidity
Oxygenation
Patients
Portal vein
Thromboembolism
Thrombosis
Transplantation
Transplants & implants
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Summary:Hepatopulmonary syndrome (HPS) is a complication of end stage liver disease (ESLD) and is manifested by severe hypoxemia, which usually responds to liver transplantation (LT). As compared to patients undergoing LT for other etiologies, patients with HPS present an increased risk of postoperative morbidity and mortality. There is no effective treatment for patients whose hypoxemia does not respond to LT. This subset of patients is at a highly increased risk of death. There are very few reports on the use of extracorporeal membrane oxygenation (ECMO) in this setting with rapid response. However, there is no prior report of ECMO utilization for longer than 4 weeks. We present the case of a 17 year-old male patient who underwent LT for ESLD secondary to chronic portal vein thrombosis and HPS. He received a liver from a deceased donor and presented with severe HPS after LT, requiring ECMO support for 67 days. The patient was discharged home and is breathing in ambient air. He is currently asymptomatic and has a normal liver function.
ISSN:0391-3988
1724-6040
DOI:10.1177/0391398821989067