Ann Surg Treat Res.  2017 Sep;93(3):152-158. 10.4174/astr.2017.93.3.152.

Extracorporeal membrane oxygenation support for refractory septic shock in liver transplantation recipients

• Lee KW
• Cho CW
• Lee N
• Choi GS
• Cho YH
• Kim JM
• Kwon CH
• Joh JW

• KMID: 2398962
• DOI: http://doi.org/10.4174/astr.2017.93.3.152

Abstract

PURPOSE
This study was designed to assess the outcome of the extracorporeal membrane oxygenation (ECMO) in liver transplantation (LT) recipients with refractory septic shock and predict the prognosis of those cases.
METHODS
From February 2005 to October 2012, ECMO was used in 8 cases of refractory septic shock. Laboratory values including lactate and total bilirubin level just before starting ECMO were obtained and sepsis-related organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACH) II score and simplified acute physiology score (SAPS) 3 were calculated. Subsequent peak serum lactate and total bilirubin level, and SOFA score after 24 hours of starting ECMO were measured.
RESULTS
Comparisons were made between survivors and nonsurvivors. ECMO was weaned off successfully in 3 patients (37.5%) and 2 patients (25%) survived to hospital discharge. Clinical scores including SOFA, APACH II, and SAPS3 and laboratory results including lactate, total bilirubin and CRP were not significantly different between survivor and nonsurvivor groups. Lactate level and SOFA score tended to decrease after ECMO support in survivor group and total bilirubin and CRP level tended to increase in nonsurvivor group.
CONCLUSION
Our findings suggest that the implantation of ECMO might be considered in highly selected LT recipients with refractory septic shock.

Keyword

Liver transplantation; Septic shock; Extracorporeal membrane oxygenation

MeSH Terms

APACHE
Bilirubin
Extracorporeal Membrane Oxygenation*
Humans
Lactic Acid
Liver Transplantation*
Liver*
Physiology
Prognosis
Shock, Septic*
Survivors
Bilirubin
Lactic Acid

Figure

• 

  Fig. 1 In the survivor group, the lactate level and the SOFA score tended to decrease over the course of ECMO treatment, and in the nonsurvivor group, the total bilirubin and CRP level tended to increase. SOFA, sepsis-related organ failure assessment; ECMO, extracorporeal membrane oxygenation.

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