Objective: To describe the experience with a multimodal therapeutic approach in a patient who developed
toxic liver syndrome and fulminant hepatic failure following orthotopic liver transplantation (OLT) as a
result of occlusion of the portal vein.
Setting: Department of Intensive Care.
Patient: A patient with liver cirrhosis secondary to autoimmune hepatitis and primary biliary cirrhosis who
underwent orthotopic liver transplantation (OLT).
Interventions: Transplant hepatectomy, plasmapheresis and retransplantation.
Case Report: A 39-year-old man underwent an elective OLT. A routine postoperative doppler ultrasound
examination a few hours after surgery revealed portal vein thrombosis. Attempts at recanalization failed,
and the patient developed acute fulminant liver failure, which remained resistant to supportive therapy. A
transplant hepatectomy was performed 9 hours later and plasmapheresis started. Following a 10-hour
anhepatic period, the patient received a second liver, from an ABO-incompatible donor. The patient
underwent column plasmapheresis and subsequent splenectomy to remove anti-B antibody to preserve the
incompatible transplanted liver from immunogenic complications. The patient spent a total of 21 days in
the Intensive Care Unit (ICU) before being discharged to a step-down ward.
Conclusion: Our experience suggests that multimodal therapy, including transplant hepatectomy,
plasmapheresis and retransplantation of an even non-ABO compatible liver may result in the successful
outcome in patients with acute fulminant liver failure complicating OLT.
Neonatal Hyperthyroidism with Fulminant Liver Failure: A Case Report
