# Application of venovenous extracorporeal membrane oxygenation combined with continuous renal replacement therapy in a high-risk liver transplant recipient: a case report

## TL;DR

A high-risk liver transplant patient with severe complications was successfully treated using a combination of VV-ECMO and CRRT, offering new hope for similar cases.

## Contribution

The novel use of VV-ECMO combined with CRRT in a high-risk liver transplant recipient expands treatment options for contraindicated patients.

## Key findings

- The patient showed significant improvement with ECMO withdrawal on postoperative day 4 and ventilator removal on day 11.
- The patient was discharged on day 61 with normal liver function, demonstrating successful graft recovery.
- Combined VV-ECMO/CRRT provides synergistic support for cardiopulmonary-renal function in high-risk liver transplants.

## Abstract

This report describes the novel perioperative application of VV-ECMO combined with CRRT in a high-risk liver transplant recipient with irreversible hypoxemia and multi-organ dysfunction, expanding therapeutic options for traditionally contraindicated patients.

A 27-year-old male with acute-on-chronic liver failure (chronic hepatitis B + alcoholic liver disease), hepatic encephalopathy, severe pulmonary infection, and coagulopathy developed life-threatening hypoxemia (PaO2 60 mmHg on FiO2 100%) during transplantation.

Emergency intraoperative VV-ECMO and postoperative CRRT were initiated.

ECMO was withdrawn on postoperative day 4, the ventilator on day 11, and the patient was discharged on day 61. Follow-up showed normal liver function.

Combined VV-ECMO/CRRT provides synergistic cardiopulmonary-renal support for high-risk liver transplants, creating a critical window for graft recovery. Multidisciplinary coordination is essential for success.