Severe hepatopulmonary syndrome with hypoxemia refractory to liver transplant : recovery after 67 days of ECMO support

• Autor(a) principal: Silva, Rodrigo Piltcher da
• Data de Publicação: 2022
• Outros Autores: Chedid, Márcio Fernandes, Grezzana Filho, Tomáz de Jesus Maria, Leipnitz, Ian, Araujo, Alexandre de, Gazzana, Marcelo Basso, Saueressig, Mauricio Guidi, Lorenzi, William, Cardoni, Mario Gurvitez, Bellaver, Priscila, Álvares-da-Silva, Mário Reis, Feier, Flávia Heinz, Chedid, Aljamir Duarte, Kruel, Cleber Rosito Pinto
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFRGS
• Texto Completo: http://hdl.handle.net/10183/267200
• topic: Doença hepática terminal; Oxigenação por membrana extracorpórea; Síndrome hepatopulmonar; Hipóxia; Transplante de fígado; Artificial lung & respiratory support; Intravascular oxygenators; ECMO; Liver transplantation; Apheresis & detoxification techniques; Artificial kidney

Hepatopulmonary syndrome (HPS) is a complication of end stage liver disease (ESLD) and is manifested by severe hypoxemia, which usually responds to liver transplantation (LT). As compared to patients undergoing LT for other etiologies, patients with HPS present an increased risk of postoperative morbidity and mortality. There is no effective treatment for patients whose hypoxemia does not respond to LT. This subset of patients is at a highly increased risk of death. There are very few reports on the use of extracorporeal membrane oxygenation (ECMO) in this setting with rapid response. However, there is no prior report of ECMO utilization for longer than 4 weeks. We present the case of a 17 year-old male patient who underwent LT for ESLD secondary to chronic portal vein thrombosis and HPS. He received a liver from a deceased donor and presented with severe HPS after LT, requiring ECMO support for 67 days. The patient was discharged home and is breathing in ambient air. He is currently asymptomatic and has a normal liver function.