Managing High-Risk Liver Transplantation: A Case of Budd-Chiari Syndrome With Preemptive Venovenous Extracorporeal Membrane Oxygenation (ECMO).

Authors

Mariana Pascoal, Luciane Pereira, Dulce Diogo, Ana Eufrásio

Published in

Cureus. Volume 18. Issue 7. Pages e112835. Epub Jul 17, 2026.

Abstract

We report the use of preemptive dual-cannula venovenous extracorporeal membrane oxygenation (VV-ECMO) during orthotopic liver transplantation in a 21-year-old patient with Budd-Chiari syndrome (BCS) with diffuse hepatic vein thrombosis and inferior vena cava (IVC) narrowing. Progressive liver dysfunction and unsuccessful transjugular intervention led to urgent transplantation. Given the anticipated intraoperative cardiopulmonary instability and surgical complexity, VV-ECMO was initiated before IVC clamping. Classic hepatectomy with portocaval shunt was performed. Portal flow was restored without post-reperfusion syndrome. Protamine was not administered, and no ECMO-related complications occurred. This case highlights the role of preemptive ECMO as a safe strategy in high-risk liver transplantation because of the anticipated severe hemodynamic instability during hepatectomy and IVC clamping due to BCS with extensive hepatic vein thrombosis and IVC stenosis, providing continuous cardiopulmonary support.

PMID:
42605358
Bibliographic data and abstract were imported from PubMed on 17 Aug 2026.

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