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

Sameer Patel; Clemens Gutmann; Robert Loveridge; Tasneem Pirani; Chris Willars; Andre Vercueil; Milena Angelova-Chee; Varuna Aluvihare; Michael Heneghan; Krishna Menon; Nigel Heaton; William Bernal; Mark McPhail; Elton Gelandt; Lisa Morgan; Michael Whitehorne; Julia Wendon; Georg Auzinger

doi:10.1016/j.ajt.2024.08.021

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

Sameer Patel^*, Clemens Gutmann, Robert Loveridge, Tasneem Pirani, Chris Willars, Andre Vercueil, Milena Angelova-Chee, Varuna Aluvihare, Michael Heneghan, Krishna Menon, Nigel Heaton, William Bernal, Mark McPhail, Elton Gelandt, Lisa Morgan, Michael Whitehorne, Julia Wendon, Georg Auzinger

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Journal	American Journal of Transplantation
DOIs	https://doi.org/10.1016/j.ajt.2024.08.021
Publication status	Accepted/In press - 2024

Keywords

bridge to liver transplantation
ECMO peri-liver transplantation
ECMO peri-LT
emergency liver transplantation (ELT)
extracorporeal membrane oxygenation (ECMO)
liver transplantation (LT)
perioperative ECMO

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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. (Accepted/In press). 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. American Journal of Transplantation. https://doi.org/10.1016/j.ajt.2024.08.021

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title = "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",

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.",

keywords = "bridge to liver transplantation, ECMO peri-liver transplantation, ECMO peri-LT, emergency liver transplantation (ELT), extracorporeal membrane oxygenation (ECMO), liver transplantation (LT), perioperative ECMO",

author = "Sameer Patel and Clemens Gutmann and Robert Loveridge and Tasneem Pirani and Chris Willars and Andre Vercueil and Milena Angelova-Chee and Varuna Aluvihare and Michael Heneghan and Krishna Menon and Nigel Heaton and William Bernal and Mark McPhail and Elton Gelandt and Lisa Morgan and Michael Whitehorne and Julia Wendon and Georg Auzinger",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2024",

doi = "10.1016/j.ajt.2024.08.021",

language = "English",

journal = "American Journal of Transplantation",

issn = "1600-6135",

publisher = "Wiley-Blackwell",

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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 2024, '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', American Journal of Transplantation. https://doi.org/10.1016/j.ajt.2024.08.021

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. / Patel, Sameer; Gutmann, Clemens; Loveridge, Robert et al.
In: American Journal of Transplantation, 2024.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Perioperative extracorporeal membrane oxygenation in liver transplantation—bridge to transplantation, intraoperative salvage, and postoperative support

T2 - outcomes and predictors for survival in a large-volume liver transplant center

AU - Patel, Sameer

AU - Gutmann, Clemens

AU - Loveridge, Robert

AU - Pirani, Tasneem

AU - Willars, Chris

AU - Vercueil, Andre

AU - Angelova-Chee, Milena

AU - Aluvihare, Varuna

AU - Heneghan, Michael

AU - Menon, Krishna

AU - Heaton, Nigel

AU - Bernal, William

AU - McPhail, Mark

AU - Gelandt, Elton

AU - Morgan, Lisa

AU - Whitehorne, Michael

AU - Wendon, Julia

AU - Auzinger, Georg

PY - 2024

Y1 - 2024

N2 - 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.

AB - 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.

KW - bridge to liver transplantation

KW - ECMO peri-liver transplantation

KW - ECMO peri-LT

KW - emergency liver transplantation (ELT)

KW - extracorporeal membrane oxygenation (ECMO)

KW - liver transplantation (LT)

KW - perioperative ECMO

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U2 - 10.1016/j.ajt.2024.08.021

DO - 10.1016/j.ajt.2024.08.021

M3 - Article

C2 - 39182613

AN - SCOPUS:85203648958

SN - 1600-6135

JO - American Journal of Transplantation

JF - American Journal of Transplantation

ER -

Patel S, Gutmann C, Loveridge R, Pirani T, Willars C, Vercueil A et al. 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. American Journal of Transplantation. 2024. doi: 10.1016/j.ajt.2024.08.021

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

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Keywords

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