title: Extracorporeal membrane oxygenation after liver transplantation in a patient with hepatopulmonary syndrome and an atrial septal defect.
abstract: BACKGROUND
  Hepatopulmonary syndrome (HPS) is a rare complication of liver cirrhosis that may result in refractory hypoxemia even after liver transplantation. ECMO has been rarely used after liver transplantation or in patients with HPS.
  
  
  METHODS
  We present a patient with HPS who underwent liver transplantation and developed refractory hypoxemia requiring postoperative ECMO support at our institution. During our review of literature we found nine reports of ECMO use for cardiorespiratory failure after liver transplant in the past.
  
  
  RESULTS
  Our patient had persistent intrapulmonary shunting and developed severe respiratory failure after liver transplant. Additionally, the patient was found to have an atrial septal defect (ASD) and required percutaneous closure while receiving ECMO support. Literature review suggests that survival among these patients who were supported with ECMO after liver transplant was 50% and catastrophic bleeding complications were described in only one report.
  
  
  CONCLUSIONS
  With careful selection of post-liver transplant patients and judicious management of anticoagulation, ECMO can be safely instituted in this cohort.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama - USA.
authors.forename: Nirmal S
authors.initials: NS
authors.lastname: Sharma
authors.forename: Keith M
authors.initials: KM
authors.lastname: Wille
authors.forename: Enrique
authors.initials: E
authors.lastname: Diaz Guzman
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications; D020065:Hepatopulmonary Syndrome / Q000150:complications / Q000601:surgery*; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D016031:Liver Transplantation; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*