RT Journal Article
T1 New therapeutic strategy with extracorporeal membrane oxygenation for refractory hepatopulmonary syndrome after liver transplant: A case report
A1 Sánchez-Pérez, Belinda
A1 Pérez Reyes, María
A1 Aranda-Narváez, José Manuel
A1 Santoyo Villalba, Julio
A1 Pérez Daga, José Antonio
A1 Sánchez González, Claudia
A1 Santoyo-Santoyo, Julio
K1 Hígado - Trasplante
K1 Hígado - Enfermedades
K1 Oxigenación por membrana extracorpórea
AB 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. In some cases, refractory hypoxemia persists, and extracorporeal membrane oxygenation(ECMO) can be used as a rescue therapy with good resultsSummary: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(MELD12).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 of 78%, forced vital capacity 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 2L/min(16h/d). The patient was admitted to the intensive care unit and extubated in the first 24h, needing high-flow therapy and non-invasive ventilation and inhaled nitric oxide afterwards.Reintubation was needed after 72h.Due to the non-response to supportive therapies, installation of ECMO was decided with progressive recovery after 9 d. Extubation was possible on the 10 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 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 saturationConclusion:Due to the favorable results observed, ECMO could become the central axis of treatment of HPS and refractory hypoxemia after LT
PB Baishideng
YR 2024
FD 2024-03-18
LK https://hdl.handle.net/10630/41330
UL https://hdl.handle.net/10630/41330
LA eng
NO 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 Mar 18;14(1):89223. doi: 10.5500/wjt.v14.i1.89223. PMID: 38576766; PMCID: PMC10989480.
DS RIUMA. Repositorio Institucional de la Universidad de Málaga
RD 21 ene 2026