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Extracorporeal membrane oxygenation for post-transplant hypoxaemia following very severe hepatopulmonary syndrome.

Publication Type : Journal Article

Thematic Areas : Medical Sciences

Publisher : BMJ Case Rep

Source : BMJ Case Rep, Volume 2017 (2017)

Keywords : adolescent, Diagnosis, Differential, Extracorporeal Membrane Oxygenation, hepatopulmonary syndrome, Humans, hypoxia, liver transplantation, male, Postoperative Complications

Campus : Kochi

School : School of Medicine

Department : Gastrointestinal Surgery, Anaesthesiology

Year : 2017

Abstract : Hepatopulmonary syndrome (HPS) associated with end-stage liver disease has a high morbidity when room air PaO is less than 50 mm Hg. Safe levels of oxygenation to facilitate transplantation have not been defined despite advancement in care. Postoperatively, hypoxaemia worsens due to ventilation perfusion mismatch contributed by postoperative pulmonary vasoconstriction and due to decrease in endogenous nitric oxide. A 16-year-old boy with cirrhosis presented with HPS and a PaO of 37 mm Hg on room air and underwent living donor liver transplant. Although stable intraoperatively, he desaturated on the second postoperative day. Despite a number of interventions, oxygenation remained critically low on 100% inspired oxygen. Extracorporeal membrane oxygenator (ECMO) was established with instant improvement in oxygenation (PaO68 mm Hg), and the patient was eventually salvaged. We suggest that ECMO could be a means of managing refractory post-transplant hypoxaemia in patients with HPS.

Cite this Research Publication : L. Kumar, Dinesh Balakrishnan, Varghese, R., and Surendran, S., “Extracorporeal membrane oxygenation for post-transplant hypoxaemia following very severe hepatopulmonary syndrome.”, BMJ Case Rep, vol. 2017, 2017.

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