Data on perioperative extracorporeal membrane oxygenation (ECMO) in liver transplantation (LT) are scarce. ECMO has been used preoperatively, intraoperatively, and postoperatively for a variety of indications at our center. This retrospective, single-center study of ECMO use peri-LT aimed to describe predictors for successful outcome in this highly select cohort of patients. Demographics, support method, and indication for LT were compared between survivors and nonsurvivors. Twenty-nine patients received venovenous (V-V; n = 20), venoarterial (V-A; n = 8), and venoarteriovenous (n = 1) ECMO. Twelve (41.4%) patients were bridged to emergency LT for acute liver failure, and emergency redo LT. Four (13.3%) patients required intraoperative V-A ECMO salvage, 2 necessitating extracorporeal cardiopulmonary resuscitation. Thirteen (43.3%) patients required ECMO support after LT: V-V ECMO (n = 9); V-A ECMO (n = 1); and extracorporeal cardiopulmonary resuscitation (n = 3) between postoperative days 2 to 30. Overall, 19 patients (65.5%) were successfully weaned off ECMO; 15 (51.7%) survived to intensive care unit discharge. All patients who underwent intraoperative salvage ECMO and all who were bridged to emergency redo LT died. Peri-LT ECMO is feasible. Post-LT ECMO outcomes are encouraging, in particular for V-V ECMO. Intraoperative ECMO salvage, uncontrolled sepsis, and graft failure are associated with poor outcomes.

中文翻译：

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肝移植围手术期体外膜氧合——移植的桥梁、术中抢救和术后支持：大型肝移植中心的预后和生存预测因素


肝移植（LT）围手术期体外膜肺氧合（ECMO）的数据很少。 ECMO 已在我们中心的术前、术中和术后用于各种适应症。这项关于 ECMO 使用 peri-LT 的回顾性单中心研究旨在描述这一精心挑选的患者队列中成功结果的预测因素。对幸存者和非幸存者的人口统计学、支持方法和 LT 指征进行了比较。 29 名患者接受了静脉静脉 (VV; n = 20)、静脉动脉 (VA; n = 8) 和静脉动静脉 (n = 1) ECMO。 12 名 (41.4%) 患者因急性肝功能衰竭转入紧急 LT，并再次接受紧急 LT。 4 名患者 (13.3%) 需要术中 VA ECMO 抢救，其中 2 名患者需要进行体外心肺复苏。 13 名 (43.3%) 患者在 LT 后需要 ECMO 支持：VV ECMO (n = 9)； VA ECMO（n = 1）；术后 2 至 30 天期间进行体外心肺复苏 (n = 3)。总体而言，19 名患者 (65.5%) 成功脱离 ECMO； 15 人 (51.7%) 幸存并出院。所有接受术中抢救 ECMO 的患者以及所有转至紧急重做 LT 的患者均死亡。 Peri-LT ECMO 是可行的。 LT ECMO 后的结果令人鼓舞，尤其是 VV ECMO。术中 ECMO 挽救、不受控制的脓毒症和移植失败与不良预后相关。