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; 14(1): 89223 [PMID: 38576766 DOI: 10.5500/wjt.v14.i1.89223]
Corresponding Author of This Article
Claudia Sanchez-Gonzalez, MD, Doctor, Department of General and Digestive Surgery, Regional University Hospital of Malaga, No. 84 Av. de Carlos Haya, Malaga 29018, Spain. csangon95@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Mar 18, 2024; 14(1): 89223 Published online Mar 18, 2024. doi: 10.5500/wjt.v14.i1.89223
New therapeutic strategy with extracorporeal membrane oxygenation for refractory hepatopulmonary syndrome after liver transplant: A case report
Belinda Sánchez Pérez, María Pérez Reyes, Jose Aranda Narvaez, Julio Santoyo Villalba, Jose Antonio Perez Daga, Claudia Sanchez-Gonzalez, Julio Santoyo-Santoyo
Belinda Sánchez Pérez, María Pérez Reyes, Jose Aranda Narvaez, Julio Santoyo Villalba, Jose Antonio Perez Daga, Julio Santoyo-Santoyo, Hepatobiliary and Trasplantation Unit, General and Digestive Surgery Department, University Regional Hospital, Malaga 29010, Spain
Claudia Sanchez-Gonzalez, Department of General and Digestive Surgery, Regional University Hospital of Malaga, Malaga 29010, Spain
Author contributions: Sánchez Pérez B wrote the manuscript; Santoyo-Santoyo J, Perez Reyes M, and Santoyo Villalba J performed the research; Aranda Narvaez J and Sánchez Pérez B performed the surgery; Perez Daga JA analyzed the data; Sanchez-Gonzalez C translated and submitted the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Claudia Sanchez-Gonzalez, MD, Doctor, Department of General and Digestive Surgery, Regional University Hospital of Malaga, No. 84 Av. de Carlos Haya, Malaga 29018, Spain. csangon95@gmail.com
Received: October 24, 2023 Peer-review started: October 24, 2023 First decision: November 21, 2023 Revised: November 24, 2023 Accepted: December 22, 2023 Article in press: December 22, 2023 Published online: March 18, 2024
Abstract
BACKGROUND
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. However, in some cases, refractory hypoxemia persists, and extracorporeal membrane oxygenation (ECMO) can be used as a rescue therapy with good results.
CASE SUMMARY
A 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 (Model for End-Stage Liver Disease score 12, Child-Pugh class B7). 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 demonstrated a forced expiratory volume in one second (FEV1) of 78%, forced vital capacity (FVC) 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 2 L/min (16 h/d). The patient was admitted to the intensive care unit (ICU) and extubated in the first 24 h, needing high-flow therapy and non-invasive ventilation and inhaled nitric oxide afterwards. Reintubation was needed after 72 h. Due to the non-response to supportive therapies, installation of ECMO was decided with progressive recovery after 9 d. Extubation was possible on the tenth 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 (POD) 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 saturation.
CONCLUSION
Due to the favorable results observed, ECMO could become the central axis of treatment of HPS and refractory hypoxemia after LT.
Core Tip: Extracorporeal membrane oxygenation (ECMO) has been used as a rescue therapy in refractory hypoxemia after liver transplant (LT) in hepatopulmonary syndrome (HPS), with positive results. We present a patient with HPS who underwent LT and developed refractory hypoxemia requiring postoperative ECMO support. The literature demonstrates an 80% survival rate with an acceptable morbi-mortality. ECMO can become the central axis in the treatment of patients with HPS which present with refractory hypoxemia after LT.
