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

Rodrigo Piltcher-da-Silva, Marcio Fernandes Chedid, Tomaz Jesus Maria Grezzana Filho, Ian Leipnitz, Alexandre de Araújo, Marcelo Basso Gazzana, Mauricio Guidi Saueressig, William Lorenzi, Mario Gurvitez Cardoni, Priscila Bellaver, Mario Reis Alvares-da-Silva, Flavia Heinz Feier, Aljamir Duarte Chedid, Cleber Rosito Pinto Kruel
International Journal of Artificial Organs 2021 January 21, : 391398821989067
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.

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