Successful combined liver-kidney transplant with intraoperative VA-ECMO and Impella 5.5 support.
Mehran Rahimi, Sarah Madira, Takuya Wada et al.
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Case in brief
A 69-year-old patient with end-stage renal disease developed refractory cardiogenic shock during combined liver-kidney transplantation. The team provided intraoperative mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and an Impella 5.5 device, a combination termed ECPELLA. Hemodynamics stabilized and the shock reversed, allowing the kidney transplant to be completed successfully. The patient subsequently had left ventricular recovery.
What made this case unusual
The case involved simultaneous intraoperative VA-ECMO and Impella 5.5 support for refractory cardiogenic shock during combined liver-kidney transplantation.
Diagnostic / clinical pearl
In this complex transplant case, combined VA-ECMO and Impella support stabilized refractory intraoperative cardiogenic shock and enabled completion of the kidney transplant.
Why it matters
The report underscores the role of interdisciplinary collaboration and careful hemodynamic management when severe shock complicates complex transplantation.