Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland.
HPB Center, University Hospitals of Geneva, Geneva, Switzerland.
Am J Transplant. 2018 Jan;18(1):258-261. doi: 10.1111/ajt.14461. Epub 2017 Sep 26.
Hemodynamic instability is generally considered as a contraindication to liver splitting, in particular when using an in situ technique. We describe the cases of two young donors with brain death in whom refractory cardiac arrest and hemodynamic instability were supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), allowing uneventful in situ splitting. Two adult and two pediatric liver recipients were successfully transplanted with immediate graft function. Favorable outcomes were also observed for the other transplanted organs, including one heart, two lungs, and four kidneys. Refractory cardiac arrest and hemodynamic instability corrected by VA-ECMO should not be considered as a contraindication to in situ liver splitting.
血流动力学不稳定通常被认为是肝劈裂的禁忌证，特别是在使用原位技术时。我们描述了两例脑死亡的年轻供体的病例，他们通过静脉-动脉体外膜肺氧合（VA-ECMO）支持难治性心脏骤停和血流动力学不稳定，从而能够顺利进行原位劈裂。两名成人和两名儿童肝受者成功接受了肝移植，移植物立即发挥功能。其他移植器官，包括 1 颗心脏、2 个肺和 4 个肾脏，也观察到了良好的结果。由 VA-ECMO 纠正的难治性心脏骤停和血流动力学不稳定不应被视为原位肝劈裂的禁忌证。
