Successful combined liver-kidney transplant with intraoperative VA-ECMO and Impella 5.5 support.

Introduction: Cardiogenic shock during liver transplantation (LT) is a significant challenge, particularly in patients with comorbidities like end-stage renal disease (ESRD). Mechanical circulatory support (MCS), including veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to manage refractory shock in these complex cases. Case Report: This case report discusses the management of a 69-year-old patient who developed intraoperative refractory cardiogenic shock while undergoing combined liver-kidney transplantation and was supported with VA-ECMO and Impella 5.5 support. The simultaneous use of VA-ECMO and Impella, or "ECPELLA," helped stabilize the hemodynamics, reverse the shock, enabling a successful KT, and subsequent left ventricular recovery. Conclusion: This case highlights the importance of interdisciplinary collaboration and careful hemodynamic management in complex transplants.