BACKGROUND: Brain death in fulminant hepatic failure (FHF) is a rare occurrence after successful orthotopic liver transplantation (OLT). Reuse of the liver graft may be considered. We report a successful OLT using such an organ in a 62-yr-old man with hematochromatosis-related cirrhosis and hepatocellular carcinoma. METHODS: Liver donor was 56-yr-old man with normal liver function tests. First recipient was a 26-yr-old woman with an acetaminophen-induced FHF. Before OLT, she developed progressive coma without obvious cerebral edema on the cerebral CT-scan. The transplantation proceeded as planned and was uneventful. However, patient exhibited bilateral non-reactive mydriasis during postoperative hours and was declared brain dead. Transplanted liver was functioning adequately. Its reuse was discussed with her family and the second recipient. After informed consent, the transplanted liver and heart were harvested. First and second liver cold ischemia times were 10 h and 75 min, respectively. RESULTS: Second recipient recovered uneventful and discharged 23 d after OLT. Liver function is still normal 30 months after OLT without rejection or hepatocellular carcinoma recurrence. CONCLUSION: Even after OLT, brain death remains possible in FHF. In absence of contraindications, reuse of transplanted liver allows for a rational use of already rare liver grafts.
BACKGROUND:Brain death in fulminant hepatic failure (FHF) is a rare occurrence after successful orthotopic liver transplantation (OLT). Reuse of the liver graft may be considered. We report a successful OLT using such an organ in a 62-yr-old man with hematochromatosis-related cirrhosis and hepatocellular carcinoma. METHODS: Liver donor was 56-yr-old man with normal liver function tests. First recipient was a 26-yr-old woman with an acetaminophen-induced FHF. Before OLT, she developed progressive coma without obvious cerebral edema on the cerebral CT-scan. The transplantation proceeded as planned and was uneventful. However, patient exhibited bilateral non-reactive mydriasis during postoperative hours and was declared brain dead. Transplanted liver was functioning adequately. Its reuse was discussed with her family and the second recipient. After informed consent, the transplanted liver and heart were harvested. First and second liver cold ischemia times were 10 h and 75 min, respectively. RESULTS: Second recipient recovered uneventful and discharged 23 d after OLT. Liver function is still normal 30 months after OLT without rejection or hepatocellular carcinoma recurrence. CONCLUSION: Even after OLT, brain death remains possible in FHF. In absence of contraindications, reuse of transplanted liver allows for a rational use of already rare liver grafts.
Authors: Hideaki Tanaka; Vivian C McAlister; Mark A Levstik; Cameron N Ghent; Paul J Marotta; Douglas Quan; William J Wall Journal: World J Hepatol Date: 2014-06-27