Park J-I, Jung B-H, Lee S-G
Department of Surgery, Inje University Haeundae Paik Hospital, and University of Inje College of Medicine, Busan, Republic of Korea.
Department of Surgery, Inje University Haeundae Paik Hospital, and University of Inje College of Medicine, Busan, Republic of Korea.
Transplant Proc. 2017 Jun;49(5):1192-1195. doi: 10.1016/j.transproceed.2017.03.030.
Post-operative respiratory failure is common in liver transplant patients, with a direct effect on graft and recipient outcomes. We present a case of successful treatment for a patient who had acute respiratory distress syndrome combined with septic shock after living-donor liver transplantation with veno-arterial-venous hybrid mode of extracorporeal membrane oxygenation (ECMO) support.
A 49-year-old male patient underwent successful emergency living-donor liver transplantation for acute-on-chronic liver failure associated with alcoholic liver cirrhosis. The patient was diagnosed with concurrent active pulmonary tuberculosis and tuberculosis peritonitis just before emergency liver transplantation. Intermittent post-operative small-bowel obstruction caused by adhesions from tuberculosis peritonitis was nonresponsive to conservative management.
On post-operative day 114, we performed emergency adhesio-lysis because of bowel ischemia signs. However, the patient had progressive deterioration of arterial oxygenation despite conventional ventilatory support and nitric oxide gas inhalation, and septic shock resulted from aspiration pneumonia. Therefore, we decided to administer ECMO. After initiation of ECMO support, hemodynamic status, pneumonic consolidation, and oxygenation status gradually improved, and the patient was weaned from ECMO on the 11th day. Finally, the patient was discharged on post-transplant day 204.
ECMO can be a beneficial rescue option for the management of refractory cardiopulmonary failure in liver transplant recipients. In addition, the hybrid mode of ECMO is a helpful salvage option when conventional modes of ECMO are inadequate.
术后呼吸衰竭在肝移植患者中很常见，直接影响移植物和受者的预后。我们报告一例活体肝移植术后急性呼吸窘迫综合征合并感染性休克患者，采用静脉-动脉-静脉混合模式体外膜肺氧合（ECMO）支持治疗成功的病例。
一名49岁男性患者因酒精性肝硬化合并慢性肝衰竭急性发作接受了成功的急诊活体肝移植。该患者在急诊肝移植前被诊断同时患有活动性肺结核和结核性腹膜炎。术后因结核性腹膜炎粘连导致间歇性小肠梗阻，保守治疗无效。
术后第114天，因出现肠缺血迹象，我们进行了急诊粘连松解术。然而，尽管给予了传统通气支持和吸入一氧化氮气体，患者的动脉氧合仍逐渐恶化，且因吸入性肺炎导致感染性休克。因此，我们决定给予ECMO治疗。开始ECMO支持后，血流动力学状态、肺部实变和氧合状态逐渐改善，患者于第11天撤离ECMO。最终，患者在移植后第204天出院。
ECMO对于肝移植受者难治性心肺衰竭的治疗可能是一种有益的挽救选择。此外，当传统ECMO模式不足时，ECMO混合模式是一种有用的挽救选择。
