Successful Extracorporeal Membrane Oxygenation Support for Acute Pulmonary Thromboembolism during Adult Liver Transplantation

Most coagulation factors are synthesized in the liver. Hence, the levels of most coagulation factors are decreased in cases of chronic liver disease. Chronic liver disease was previously considered as an acquired bleeding disorder, and basic laboratory tests of anticoagulation, including prothrombin time and activated partialthromboplastin time (aPTT), were used to assess the risk of bleeding.[1] However, a new hypothesis states that the coagulation system is rebalanced in chronic liver disease, with a decrease in the levels of natural anticoagulant factors, such as protein C and anti-thrombin, and a decrease in the levels of most of the coagulation factors under physiologic conditions.[1] Moreover, patients with chronic liver disease are considered to be procoagulant in many reports.[2,3] This could be explained by the increased levels of factor VIII mediated by the von Willebrand factor.[4,5] Consequently, patients with chronic liver disease are more likely to be at increased risk of venous or arterial thrombosis.[6-8] Here, we report a case of acute pulmonary thromboembolism that developed during adult liver transplantation (LT), which was managed successfully with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support.