The role of extracorporeal membrane oxygenation in adult liver transplant patients: A qualitative systematic review of literature

Reid, Trista; Kratzke, Ian M.; Dayal, Diana; Raff, Lauren; Serrano, Pablo E.; Kumar, Aman; Zendel, Alex; Herdman, Victoria; Gallaher, Jared; McCall, Rebecca; Charles, Anthony; Desai, Chirag S.

doi:10.1111/aor.14120

Cited by 9 publications

(8 citation statements)

References 63 publications

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“…Two additional systematic reviews have assessed liver transplantation from ECMO-supported donors, which importantly did not specifically denote whether ECMO cannulation was performed for donation or therapeutic intent and have also noted generally acceptable outcomes. The first, assessing 187 liver transplants, noted a 1-year patient survival of 89.8%, PNF incidence of 1.6%, and bile leak/stricture rate of 13.2%, 9 while the second, specifically examining DBD VA-ECMO-supported donors, identified 17 studies contributing 156 liver transplants, and noted a pooled PNF incidence of 1% and acceptable, similar 1-year graft survival in 16 of 17 investigations 16 . Our observed 87.1% 1-year graft survival with zero cases of PNF, therefore, appears largely concordant with the published literature, although, like many of the previously published studies, our data source limits our ability to make significant conclusions related to biliary complications.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies assessing the use of ECMO to improve donor utilization have largely focused on ECMO as a strategy to stabilize donors specifically for the purpose of organ donation 2–6 . The few studies assessing transplantation patterns and outcomes when using organs from ECMO-supported donors who were cannulated for non–organ donation purposes have shown reasonable outcomes to promote their use in select settings 7–10 . These studies, however, have been limited by small sample sizes, which limit the extent of their analyses.…”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal membrane oxygenation for cardiopulmonary failure in organ donation: Assessing liver transplant outcomes

Altshuler

Preston

Pace

et al. 2023

Liver Transplantation

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Liver transplantation continues to face significant organ shortages and efficient utilization of marginal donors is paramount. This study evaluates the practice patterns and outcomes in liver transplantation when utilizing allografts from marginal donors who required extracorporeal membrane oxygenation (ECMO) support. We performed a retrospective review of the Gift of Life (PA, NJ, DE) organ-procuring organization database for transplants performed using donors supported on ECMO for nondonation purposes. These were cross-referenced to the transplant recipients within the Organ Procurement and Transplantation Network database, and the outcomes of liver transplants using donors on ECMO support were compared with those not requiring ECMO. Organ use and nonuse patterns were then evaluated in ECMO-supported donors, identifying the factors associated with nonuse compared with the factors associated with graft failure. Thirty-nine of the 84 ECMO-supported donors contributing at least one intra-abdominal organ for transplant donated a liver. Graft survival and patient survival up to 5 years were comparable between transplants from ECMO and non-ECMO-supported donors, and no cases of primary nonfunction were seen in the ECMO group. ECMO support was not associated with 1-year graft failure on regression modeling. Additional regression analyses within the ECMO donor population identified bacteremia (HR: 19.81) and elevated total bilirubin at donation (HR: 2.44) as predictive of post-transplant graft failure. Livers from donors supported on ECMO before donation appear safe to use in select transplant settings. Better understanding of the impact of predonation ECMO on liver allograft function will help guide the optimal use of these scarcely used donors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation for cardiopulmonary failure in organ donation: Assessing liver transplant outcomes

Altshuler

Preston

Pace

et al. 2023

Liver Transplantation

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“…Reid et al performed a systematic review of literature published from January 1, 2000 to April 24, 2020 on adult LT recipients (pre- or post-transplant) who underwent ECMO. 68 Forty-one articles were identified that fit the criteria. Sixty-one recipients were placed on ECMO intraoperatively or postoperatively.…”

Section: Liver Transplantationmentioning

confidence: 99%

Abdominal Organ Transplantation: Noteworthy Literature in 2022

Nolasco

Igwe

Sakai

2023

Semin Cardiothorac Vasc Anesth

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This review highlights noteworthy literature published in 2022 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We begin by exploring the impacts that the COVID-19 pandemic has had across the field of abdominal organ transplantation, including the successful use of grafts procured from COVID-19-infected donors. In pancreatic transplantation, we highlight several studies on dexmedetomidine and ischemia-reperfusion injury, equity in transplantation, and medical management, as well as studies comparing pancreatic transplantation to islet cell transplantation. In our section on intestinal transplantation, we explore donor selection. Kidney transplantation topics include cardiovascular risk management, obesity, and intraoperative management, including fluid resuscitation, dexmedetomidine, and sugammadex. The liver transplantation section focuses on clinical trials, systematic reviews, and meta-analyses published in 2022 and covers a wide range of topics, including machine perfusion, cardiovascular issues, renal issues, and coagulation/transfusion.

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“…However, there are limited data and sporadic case reports on the use of ECMO in kidney transplantation, both pre‐donation, and post‐transplantation 12 . Our group has performed systematic reviews of the use of ECMO in pediatric liver and kidney transplantation, as well as adult liver transplantation 13,14 . The purpose of this study was to perform a qualitative, systematic review and analyze all existing literature regarding outcomes, complications, and mortality for adult patients receiving veno‐venous (VV) or veno‐arterial (VA) ECMO support, either pre‐ or postrenal transplant.…”

Section: Introductionmentioning

confidence: 99%

“…12 Our group has performed systematic reviews of the use of ECMO in pediatric liver and kidney transplantation, as well as adult liver transplantation. 13,14 The purpose of this study was to perform a qualitative, systematic review and analyze all existing literature regarding outcomes, complications, and mortality for adult patients receiving veno-venous (VV) or veno-arterial (VA) ECMO support, either pre-or postrenal transplant. With this review, we aim to evaluate the impending role of ECMO in kidney transplant patients to inform practice guidelines.…”

mentioning

confidence: 99%

The role of extracorporeal membrane oxygenation in adult kidney transplant patients: A qualitative systematic review of literature

et al. 2022

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Background A paucity of evidence exists regarding the risks and benefits of Extracorporeal Membrane Oxygenation (ECMO) in adult kidney transplantation. Methods This was a systematic review conducted from Jan 1, 2000 to April 24, 2020 of adult kidney transplant recipients (pre‐ or post‐ transplant) and donors who underwent veno‐arterial or veno‐venous ECMO cannulation. Death and graft function were the primary outcomes, with complications as secondary outcomes. Results Twenty‐three articles were identified that fit inclusion criteria. 461 donors were placed on ECMO, with an overall recipient 12‐month mortality rate of 1.3% and a complication rate of 61.5%, the majority of which was delayed graft function. Fourteen recipients were placed on ECMO intraoperatively or postoperatively, with infection as the most common indication for ECMO. The 90‐day mortality rate for recipients on ECMO was 42.9%, with multisystem organ failure and infection as the ubiquitous causes of death. 35.7% of patients experienced rejection within 6 months of decannulation, yet all were successfully treated. Conclusions ECMO use in adult kidney transplantation is a useful adjunct. Recipient morbidity and mortality from donors placed on ECMO mirrors that of recipients from standard criteria donors. The morbidity and mortality of recipients placed on ECMO are also similar to other patient populations requiring ECMO.

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The role of extracorporeal membrane oxygenation in adult liver transplant patients: A qualitative systematic review of literature

Cited by 9 publications

References 63 publications

Extracorporeal membrane oxygenation for cardiopulmonary failure in organ donation: Assessing liver transplant outcomes

Extracorporeal membrane oxygenation for cardiopulmonary failure in organ donation: Assessing liver transplant outcomes

Abdominal Organ Transplantation: Noteworthy Literature in 2022

The role of extracorporeal membrane oxygenation in adult kidney transplant patients: A qualitative systematic review of literature

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