In this retrospective cohort study, we identified an elevated 1-year mortality rate among patients who developed postoperative liver dysfunction, as defined by the presence of HLD, DILI-like symptoms, and cholestasis subsequent to LuTX with intraoperative ECMO support.

It was most pronounced in patients exhibiting HLD.

Even though roughly 90% of patients were operated on VA-ECMO in this cohort, the incidence of HLD was only slightly higher as in the cohort investigated by Hyzny and colleagues who exhibited a 44% perioperative support rate yet with more frequent use of CPB (4% vs. 2% in our setting).

In contrast, to DILI-like symptoms and cholestasis, HLD remained the only independent factor in the multivariate cox regression for 1-year mortality.

The survival rate of patients exhibiting HLD of 65% in our cohort, was still higher as in the patients reported by Hyzny et al (approximately 25%), despite the higher incidence of HLD at our institution.

However, these differences, may be explained by the higher ALT and AST threshold levels (i.e., 20 times the upper limit of normal) Hyzny and colleagues applied for the definition of HLD. Interestingly, patients exhibiting HLD post-LuTX were notably more frequently subjected to transplantation on CPB, bridged to LuTX on ECMO, or necessitated postoperative ECMO support.

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