title: Intensive pulmonary support using extracorporeal membrane oxygenation in adult patients undergoing liver transplantation.
abstract: OBJECTIVE
  Adult liver transplantation (LT) recipients occasionally show serious acute cardiopulmonary dysfunction, requiring intensive care. We have assessed the feasibility of extracorporeal membrane oxygenation (ECMO) support in adult LT recipients facing acute pulmonary failure and refractory to conventional mechanical ventilation and concurrent nitric oxide gas inhalation.
  
  
  METHODS
  From January 2008 to June 2009, 9 adult LT recipients required ECMO support due to pneumonia (n=5) and adult respiratory distress syndrome (n=4). Mean age was 52.6 ± 5.9 years and mean model for end-stage liver disease score was 29.0 ± 7.5. Five patients underwent living-donor LT and four underwent deceased-donor LT.
  
  
  RESULTS
  Veno-venous access mode was used and continuous veno-venous hemodiafiltration was performed concurrently in all 9 patients. No procedure related complications occurred. Successful ECMO weaning was achieved in 4 patients (44.4%) at the first attempt, after mean ECMO support of 12.0 ± 6.8 days but the other five died due to overwhelming infection prior to ECMO weaning. Univariate analysis revealed no significant risk factors for failing ECMO support before ECMO start.
  
  
  CONCLUSIONS
  ECMO as rescue therapy seems beneficial to be considered as a final therapeutic option for LT recipients with refractory pulmonary dysfunction who would otherwise die due to hypoxemia.
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Nam-Kyu
authors.initials: NK
authors.lastname: Choi
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Kwan-Woo
authors.initials: KW
authors.lastname: Kim
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.forename: Young-Dong
authors.initials: YD
authors.lastname: Yu
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jung
authors.forename: Pyung-Jae
authors.initials: PJ
authors.lastname: Park
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Choi
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Suk-Kyung
authors.initials: SK
authors.lastname: Hong
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012307:Risk Factors