Introduction: Postoperative severe cardiopulmonary failure carries a high rate of mortality. Extracorporeal membrane oxygenation (ECMO) has been used as a salvage therapy when conventional therapies fail. We reviewed our experience with ECMO support in the early postoperative period after liver transplant.

Methods: Retrospective review of all patients who developed cardiopulmonary failure requiring ECMO support in the postoperative period after liver transplant between September 2011 and May 2016. All patients who underwent arteriovenous (AV) or venovenous (VV) ECMO were included.

Results: Out of 537 liver transplants performed at our institution, 7 patients required ECMO support with a median age of 52 and a median MELD score of 29. Etiology of liver disease, indication for liver transplant, and indication for ECMO are shown in the following table. VV ECMO was used in 4 patients with severe respiratory failure while the rest required AV ECMO for circulatory failure from right ventricular outflow obstruction. The median time from transplant to cannulation was 5 days with a median duration of ECMO support of 10 days. All patients except one were successfully decannulated. The median hospital length of stay was 59 days. In hospital mortality of was 28.6% with both patients died of overwhelming fungemia. One-year survival is illustrated in the following Kaplan-Meier curve.

Conclusion: ECMO should be strongly considered as a rescue therapy in the setting of severe postoperative cardiopulmonary failure. ECMO therapy was a successful modality to salvage 30 day survival from acute cardiopulmonary events post-transplant, but was overall associated with a high mortality.

CITATION INFORMATION: Goussous N, Hanish S, LaMattina J, Kon Z, Potosky D, Scalea J, Hutson W, Barth R, Bruno D. ECMO in Liver Transplant. Am J Transplant. 2017;17 (suppl 3).

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