Retrospective observation of therapeutic effects of adult auxiliary partial living donor liver transplantation on postpartum acute liver failure: A case report

We present a female patient with preterm labor, severe viral hepatitis B of acute phase, hepatic encephalopathy stage Ⅲ and coma.After delivery, the illness was exacerbated and the patient presented with clinical signs of vital organ dysfunctions such as acute respiratory distress syndrome, cerebral...

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Bibliographic Details
Published inWorld journal of gastroenterology : WJG Vol. 21; no. 9; pp. 2840 - 2847
Main Authors Li, Chuan-Yun, Lai, Wei, Lu, Shi-Chun
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Inc 07.03.2015
Subjects
Adult
Antiviral Agents - therapeutic use
Auxiliary
Biopsy
Case Report
Disease Progression
donor
Female
Hepatitis B - diagnosis
Hepatitis B - surgery
Hepatitis B - virology
Humans
Immunosuppressive Agents - therapeutic use
liver
Liver Failure, Acute - diagnosis
Liver Failure, Acute - surgery
Liver Failure, Acute - virology
Liver Transplantation - methods
living
Living Donors
Obstetric Labor, Premature - diagnosis
Obstetric Labor, Premature - virology
orthotopic
partial
Pregnancy
Pregnancy Complications, Infectious - diagnosis
Pregnancy Complications, Infectious - surgery
Pregnancy Complications, Infectious - virology
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Acute liver failure
Hepatitis B virus
Anti-hepatitis B virus immunoglobulin
Auxiliary partial orthotopic living donor liver transplant
Entecavir
Postpartum
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Summary:We present a female patient with preterm labor, severe viral hepatitis B of acute phase, hepatic encephalopathy stage Ⅲ and coma.After delivery, the illness was exacerbated and the patient presented with clinical signs of vital organ dysfunctions such as acute respiratory distress syndrome, cerebral edema and hypoxemia that needed mechanical ventilation.Emergency liver transplantation was recommended after multidisciplinary panel consultations.The donor, her mother, consented to donate her right liver.Auxiliary partial orthotopic living donor liver transplantion(APOLDLT) was performed.After operation, the patient was on triple medication of tacrolimus plus mofetil mycophenolate and prednisone for immunosuppression.The combination of antihepatitis B virus(HBV) immunoglobulin and entecavir was initiated for anti-HBV therapy.Both the patient and the donor recovered well without any complications.The patient was followed up regularly.Her liver function, clinical signs and symptoms improved significantly.Until now, the recipient has been living for more than 78 mo free of any complications.The APOLDLT is a life-saving modality for rescuing patients with high-risk acute liver failure following HBV infection without available donor and hence is recommended under standardized antiviral therapy coverage as stated above.
Bibliography:We present a female patient with preterm labor, severe viral hepatitis B of acute phase, hepatic encephalopathy stage Ⅲ and coma.After delivery, the illness was exacerbated and the patient presented with clinical signs of vital organ dysfunctions such as acute respiratory distress syndrome, cerebral edema and hypoxemia that needed mechanical ventilation.Emergency liver transplantation was recommended after multidisciplinary panel consultations.The donor, her mother, consented to donate her right liver.Auxiliary partial orthotopic living donor liver transplantion(APOLDLT) was performed.After operation, the patient was on triple medication of tacrolimus plus mofetil mycophenolate and prednisone for immunosuppression.The combination of antihepatitis B virus(HBV) immunoglobulin and entecavir was initiated for anti-HBV therapy.Both the patient and the donor recovered well without any complications.The patient was followed up regularly.Her liver function, clinical signs and symptoms improved significantly.Until now, the recipient has been living for more than 78 mo free of any complications.The APOLDLT is a life-saving modality for rescuing patients with high-risk acute liver failure following HBV infection without available donor and hence is recommended under standardized antiviral therapy coverage as stated above.
Auxiliary partial orthotopic living donor liver tr
Chuan-Yun Li;Wei Lai;Shi-Chun Lu;Department of Hepatobiliary Surgery and Liver Transplantation Center,Beijing You-An Hospital,Capital Medical University;Department of Hepatobiliary Surgery,the First People’s Hospital of Chengdu;Institute and Hospital of Hepatobiliary Surgery,Key Laboratory of Digital Hepatobiliary Surgery of Chinese PLA,Chinese PLA Medical School,Chinese PLA General Hospital
ObjectType-Case Study-2
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Author contributions: Li CY drafted the manuscript and statistical analyses; The experiments were designed by Lu SC; The experiments were performed by Lai W; Lu SC supervised and coordinated the study; all authors have read and approved the final manuscript.
Correspondence to: Shi-Chun Lu, MD, Institute and Hospital of Hepatobiliary Surgery, Key Laboratory of Digital Hepatobiliary Surgery of Chinese PLA, Chinese PLA Medical School, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100853, China. lsc620213@aliyun.com
Telephone: +86-10-63296493 Fax: +86-10-63296493
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v21.i9.2840