Postoperative Liver Dysfunction: Unveiling the Impact of ECMO on Lung Transplant Outcomes in new study

Recent study analyzed postoperative liver dysfunction following lung transplantation with extracorporeal life support and its impact on outcomes, focusing on hypoxic liver dysfunction (HLD), drug-induced liver injury (DILI), and cholestasis. The research identified discrepancies in survival probabilities among patients with HLD and DILI-like symptoms, with HLD remaining an independent risk factor for 1-year mortality. Despite a higher incidence of HLD in patients operated on venoarterial extracorporeal membrane oxygenation (VA-ECMO), their 1-year survival rate was comparatively higher. Patients with HLD were frequently operated on cardiopulmonary bypass (CPB) or required postoperative ECMO support, potentially due to compromised hepatic perfusion.

CPB Utilization and Ischemic Hepatitis

The study discussed the association between CPB utilization and postoperative ischemic hepatitis, highlighting ECMO support's impact on liver perfusion and hepatic metabolic demand post-transplantation. Moreover, patients with DILI-like symptoms and cholestasis who received more than 8 packed red blood cell (PRBC) transfusions had an increased risk of mortality. The investigation also identified end-stage interstitial lung disease and COVID-19-related acute respiratory distress syndrome (ARDS) or fibrosis as independent predictors of 1-year mortality.

Impact on ICU Stay and Mortality

Statistical analyses revealed significant associations between hepatic dysfunction types (HLD, DILI, cholestasis) and increased ICU stay length, with HLD independently linked to higher 1-year mortality. The study emphasized the challenges in distinguishing between drug-induced and hypoxic liver dysfunction in the post-transplant setting due to polypharmacy and complex clinical scenarios. It suggested that brief VA-ECMO deployment may be less harmful than prolonged use or CPB in terms of postoperative HLD risk.

Methodology and Data Analysis

The research methodology involved retrospective data analysis of 1,350 lung transplant patients, with detailed recording of patient demographics, liver function tests, and outcome parameters like mechanical ventilation days and 1-year survival. Definitions for hepatic dysfunction types (HLD, DILI, cholestasis) were outlined, with key criteria for each category established. The study concluded that post-LuTX liver dysfunction, especially HLD, significantly impacts patient outcomes, urging the need for effective prevention strategies.

Study's Conclusion

In conclusion, the study sheds light on the incidence of postoperative liver dysfunction following lung transplantation with extracorporeal life support, emphasizing the importance of differentiating between HLD, DILI, and cholestasis. It highlights the elevated mortality risk associated with HLD and underscores the potential impact of ECMO support and transfusions on patient outcomes. The research calls for further prospective studies to elucidate specific risk factors for hepatic dysfunction post-transplantation and develop targeted preventive measures to enhance patient care.

Key Points

- The study assessed postoperative liver dysfunction after lung transplantation with extracorporeal life support, focusing on hypoxic liver dysfunction (HLD), drug-induced liver injury (DILI), and cholestasis. Survival probabilities differed among patients with HLD and DILI-like symptoms, with HLD remaining a risk factor for 1-year mortality.

- Patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) had a higher incidence of HLD but showed comparatively higher 1-year survival rates. Patients with HLD often underwent cardiopulmonary bypass (CPB) or postoperative ECMO due to compromised hepatic perfusion.

- The study discussed the link between CPB utilization and postoperative ischemic hepatitis, with ECMO support affecting liver perfusion and metabolic demand post-transplantation. Patients with DILI-like symptoms and cholestasis who received more than 8 packed red blood cell (PRBC) transfusions had increased mortality risks.

- Association between hepatic dysfunction types (HLD, DILI, cholestasis) and prolonged ICU stay was noted, with HLD independently associated with higher 1-year mortality. Distinguishing between drug-induced and hypoxic liver dysfunction post-transplantation was challenging due to polypharmacy and complex clinical scenarios.

- Methodology included analyzing data from 1,350 lung transplant patients, detailing demographics, liver function tests, mechanical ventilation days, and 1-year survival. Definitions for hepatic dysfunction types were established, concluding that HLD significantly impacts patient outcomes and advocating for preventive strategies.

- The study underscores the importance of identifying HLD, DILI, and cholestasis post-lung transplantation with extracorporeal life support, emphasizing the mortality risk associated with HLD. It suggests the potential impacts of ECMO support and transfusions on outcomes and calls for prospective studies to identify risk factors and preventive measures for post-transplant hepatic dysfunction.

Reference –

C. Veraar et al. (2025). Postoperative Liver Dysfunction After Lung Transplantation With Extracorporeal Life Support And 1-Year Mortality-A Cohort Study.. *Journal Of Cardiothoracic And Vascular Anesthesia*. https://doi.org/10.1053/j.jvca.2025.02.012.