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Postoperative Liver Dysfunction After Lung Transplantation With Extracorporeal Life Support and 1-Year Mortality-A
Cecilia Veraar1, Stefan Schwarz2, Caroline Hillebrand2
1Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
Journal of Cardiothoracic and Vascular Anesthesia
|February 23, 2025
Summary
Lung transplantation using cardiopulmonary bypass (CPB) or prolonged extracorporeal membrane oxygenation (ECMO) increases liver injury risk and worsens outcomes. Brief ECMO use does not appear to carry this risk.
Area of Science:
- Cardiology
- Transplantation Surgery
- Hepatology
Background:
- Extracorporeal life support (ECL) methods like venovenous/venoarterial extracorporeal membrane oxygenation (ECMO) and cardiopulmonary bypass (CPB) can cause inflammation and liver dysfunction.
- Postoperative liver dysfunction following lung transplantation is associated with adverse clinical outcomes.
Purpose of the Study:
- To investigate the incidence of liver injury after lung transplantation.
- To determine the impact of liver injury on intensive care unit (ICU) stay and 1-year mortality.
- To analyze the association between specific ECL methods and liver injury.
Main Methods:
- Retrospective analysis of 1,350 consecutive lung transplant patients.
- Data collected between January 2009 and April 2023.
- Classification of hepatic injury into hypoxic liver dysfunction, drug-induced liver injury, and cholestasis.
Main Results:
- Incidences of hypoxic liver dysfunction, drug-induced liver injury, and cholestasis were 4%, 23%, and 52%, respectively.
- All types of liver injury correlated with increased ICU stay.
- Hypoxic liver dysfunction was independently linked to a 35% increase in 1-year mortality and was associated with CPB or prolonged ECMO use.
Conclusions:
- Lung transplantation requiring CPB or extended perioperative ECMO significantly elevates the risk of severe postoperative liver dysfunction and poorer outcomes.
- Brief intraoperative ECMO deployment does not seem to pose the same risk for liver dysfunction.
