Extra-corporeal membrane oxygenation (ECMO) is a therapeutic modality used to treat refractory hypoxemia, and help support cardiogenic shock. These conditions are seen in liver transplant recipients, particularly those with hepatopulmonary syndrome (HPS), portopulmonary hypertension and post-cardiac arrest. Yet, it is unknown the optimal application of ECMO in these patients. Therefore, to guide future applications of ECMO, we aim to describe the usage of ECMO in liver transplant recipients at our center.

We reviewed the 323 liver transplants done from Jan. 2015 to Nov. 2017, and we found the six cases in which ECMO was used. Veno-venous (VV) ECMO was used in three of the patients for hypoxemia. These patients were initiated on ECMO between 18-69 days after their liver transplant. They were all weaned off ECMO, and were alive at 30 days after discontinuing ECMO support. Veno-arterial (VA) ECMO was used in the other three patients for right heart failure, two of whom sustained cardiac arrests prior to ECMO. These three patients were emergently placed on ECMO during their liver transplant. Two of these patients passed away the same day – one from allograft failure, the other from inability to continue ECMO. The remaining patient survived until post-transplant day (PTD) 4 until he sustained a massive brain hemorrhage.

From our center, it appears VV-ECMO used for hypoxemia may have better outcomes than VA-ECMO used for right heart failure. Furthermore, implementing intra-operative ECMO as salvage therapy following cardiac arrest in liver transplant recipients should be carefully considered as none of our patients survived the wean off ECMO. Certainly, further investigation is needed prior to making practice recommendations.

CITATION INFORMATION: Nguyen B., Dhanireddy K., Genyk Y., Kaur N. The Utility and Futility of Extra-Corporeal Membrane Oxygenation in Liver Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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