1. Prolonged Anhepatic State as a Bridge to Retransplantation: A Challenging Case of a 35-Year-Old Male Liver Transplant Patient with a Temporary Portacaval Shunt.
- Author
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Coelho, David Richer Araujo, da Luz, Rogerio Oliveira, Basto, Samanta Teixeira, de Sousa, Claudia Cristina Tavares, da Silva, Henry Pereira, Fernandes, Eduardo de Sousa Martins, and Brito-Azevedo, Anderson
- Subjects
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LIVER transplantation , *PROPOFOL infusion syndrome , *AUTOIMMUNE hepatitis , *OPERATIVE surgery , *BRAIN death , *LIVER failure - Abstract
Objective: Management of emergency care Background: Liver transplantation is a life-saving intervention for patients with a diagnosis of acute liver failure or endstage liver disease. Despite advances in surgical techniques and immunosuppressive therapies, primary nonfunction remains a concern, often necessitating retransplantation. In these scenarios, the anhepatic state, achieved through total hepatectomy with a temporary portacaval shunt, serves as a bridge to retransplantation. However, the challenge lies in the uncertain survival period and several potential complications associated with this procedure. Case Report: We present a case of a 35-year-old male patient with autoimmune hepatitis who underwent liver transplantation from a deceased donor. Seven days later, he experienced acute liver failure, leading to an urgent listing for retransplantation. To prevent the intense systemic inflammatory response, the patient underwent a total hepatectomy with a temporary portacaval shunt while awaiting another graft and endured a 57-h anhepatic state. On day 17 following retransplantation, he had cerebral death due to a hemorrhagic stroke. Conclusions: This case underscores one of the most prolonged periods of anhepatic state as a bridge to retransplantation, highlighting the complexities associated with this technique. The challenges include sepsis, hypotension, coagulopathy, metabolic acidosis, renal failure, electrolyte disturbances, hypoglycemia, and hypothermia. Vigilant monitoring and careful management are crucial to improve patient outcomes. Further research is needed to optimize the duration of the anhepatic state and minimize complications for liver transplantation recipients. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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