Auxiliary partial liver transplantation for acute liver failure using "high risk" grafts: Case report

Abstract

Acute liver failure (ALF) is a reversible disorder that is associated with an abrupt loss of hepatic mass, rapidly progressive encephalopathy and devastating complications. Despite its high mortality, an emergency liver transplantation nowadays forms an integral part in ALF management and has substantially improved the outcomes of ALF. Here, we report the case of a 32-year-old female patient who was admitted with grade IV hepatic encephalopathy (coma) following drug-induced ALF. We performed an emergency auxiliary partial orthotopic liver transplantation with a "high risk" graft (liver macrovesicular steatosis approximately 40%) from a living donor. The patient was discharged on postoperative day 57 with normal liver function. Weaning from immunosuppression was achieved 9 mo after transplantation. A follow-up using CT scan showed a remarkable increase in native liver volume and gradual loss of the graft. More than 6 years after the transplantation, the female now has a 4-year-old child and has returned to work full-time without any neurological sequelae.

Keywords: Acute liver failure; Auxiliary partial orthotopic liver transplantation; Fatty liver graft.

Figure 1

Histopathological finding of the donor and the recipient liver by Hematoxylin-Eosin staining. A: The preoperative specimen of biopsy from the donor showed approximately 40% macrovesicular steatosis; B: The preoperative specimen from the recipient showed 50% hepatocytes loss.

Figure 2

Serial computed tomographic findings of the native liver and graft. The volume of the native right liver (on the left side of the black dotted line) in the recipient serially increased and the volume of the graft (on the right side of the black dotted line) notably decreased after transplantation (A-F). The CT scans were performed on posttransplant day 28 (A), 132 (B), 182 (C), 222 (D), 365 (E), and 567 (F), respectively. CT: Computed tomography.