Abstract
INTRODUCTION: 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. CASE PRESENTATION: 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 (PaO(2) 60 mmHg on FiO(2) 100%) during transplantation. INTERVENTIONS: Emergency intraoperative VV-ECMO and postoperative CRRT were initiated. OUTCOMES: ECMO was withdrawn on postoperative day 4, the ventilator on day 11, and the patient was discharged on day 61.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. CONCLUSION: 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.