Korean J Transplant.  2023 Nov;37(Suppl 1):S233. 10.4285/ATW2023.F-8267.

First experience of liver transplantation after liver trauma: a case report

• Shim JR
• Ryu JH
• Choi BH
• Lee TB
• Yang K

• KMID: 2551853
• DOI: http://doi.org/10.4285/ATW2023.F-8267

Abstract

The liver is the most damaged organ in abdominal trauma. In most cases, conservative treatment is selected, but surgery may be required in abdominal trauma with severe liver damage, especially uncontrolled bleeding. Despite the damage control approach to achieve hemodynamic stability, many patients could be dead because of acute hepatic failure which lead to multiple organ failure. In this situation, liver transplantation can be as the lifesaving last resource. With this possibility, we report a case of patient who received liver transplantation after liver trauma. Thirty-six-year-old male was injured by a factory machine, and thoracic and abdominal blunt trauma were caused. Angiographic embolization was performed to control a severe hepatic hemorrhage. But it caused massive ischemic damage of liver, soon hepatic failure was appeared. The patient was transferred to our center, deceased donor liver transplantation with hepaticojejunostomy was performed. Because of thoracic blunt trauma, hemothorax was controlled with surgery. And also thoracic trauma caused huge subcutaneous hemorrhage of chest wall, fat tissue defect. This defect was controlled with vacuum dressing, and skin graft was applied by patients thigh skin. But unfortunately, in process of recovery, generalized tonic seizure was occurred, and brain computed tomography scan showed hydrocephalus. So EVD was performed, and after liver function was recovered, VP shunt was followed. This process of recovery was about 3 months. And after that, there was crisis of death caused by pneumonia, but fortunately, the patient was overcome. And also, stabilized liver function was worsened by acute rejection, but it was controlled by high dose steroid therapy. The patient was bedridden for a long-long time, and is still in our center. But, he can even joke because his condition has recovered as well, and nowadays, the main treatment is focused on rehabilitation.