A CLINICAL CASE OF SEQUENTIAL EXTRACORPOREAL THERAPY IN A PATIENT WITH MULTIPLE ORGAN FAILURE, SEPSIS, PANCREATIC NECROSIS AND REJECTION CRISIS AFTER ORTHOTOPIC HEART TRANSPLANTATION

Highlights

Sequential extracorporeal therapy is a multi-organ support strategy for the treatment of critical illnesses that pathogenetically addresses the underlying cause of organ failure. This article reports a rare case of sequential extracorporeal therapy, which significantly prolonged the life of a patient with severe multiple organ failure after orthotopic heart transplantation.

Abstract

This article describes a clinical case of a 52-year-old man with ischemic cardiomyopathy, chronic left ventricular aneurysm, multiple myocardial cicatricial changes, diabetes mellitus and postcholecystectomy syndrome, who underwent orthotopic heart transplantation. After surgery he had developed sepsis and septic shock due to nosocomial pneumonia, pancreatic necrosis, acute renal and liver failure. Postoperative period was complicated by a crisis of rejection of the donor heart and pulmonary embolism. We used therapeutic plasma exchange, prolonged renal replacement therapy with the use of CytoSorb, Jafron and Toraymyxin sorption columns, as well as extracorporeal membrane oxygenation in the treatment process. As a result of progression of multiple organ failure, the patient died, but thanks to targeted use of extracorporeal technologies it was possible to prolonge the patient's life for 42 days. Consistent use of various methods of extracorporeal therapy has demonstrated its effectiveness, but further studies are needed to standardize their use in the aim to determine the target group of patients and select the optimal technology.

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