Ann Liver Transplant.  2024 Nov;4(2):112-116. 10.52604/alt.24.0015.

Deceased donor liver transplantation for post-hepatectomy liver failure with fixed pupils

• An S
• Kim J
• Jo S
• Oh N
• Gil E
• Kim G

• KMID: 2561857
• DOI: http://doi.org/10.52604/alt.24.0015

Abstract

Deceased donor liver transplantation (DDLT) raises ethical and social questions about liver transplantation for patients who are not expected to live. Patients with post-hepatectomy liver failure must have DDLT as soon as possible. Here, we detail a particular dilemma that the transplant team had while deciding whether to harvest liver from a deceased donor in the face of the recipient’s non-reactive, fully dilated pupils while they awaited a liver transplant in the intensive care unit. Despite having fixed dilated pupils during the neurologic evaluation, the patient eventually had effective DDLT, indicating that DDLT should not be done unless there is obvious brain death.

Keyword

Liver failure; Postoperative complications; Esophageal and gastric varices; Tissue and organ procurement; Neurologic examination

Figure

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  Figure 1 (A) Multiple tumors in preoperative liver images (arrow), (B) specimen after laparoscopic right hepatectomy, (C) change of platelet count after surgery, (D) change of international normalized ratio after surgery, and (E) change of total bilirubin after surgery.

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  Figure 2 (A) Multiple hypoattenuating lesions in the remnant liver, (B) bleeding focus on endoscopy in the emergency room, (C) blood oozing in the gastroesophageal junction in the intensive care unit, (D) explant liver, and (E) harvested liver graft from a deceased donor.

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  Figure 3 Post-transplant laboratory changes. (A) AST, (B) ALT, (C) total bilirubin, (D) platelet count, and (E) serum creatinine. AST, aspartate transaminase; ALT, alanine transaminase; CRRT, continuous renal replacement therapy.

Reference

1. Rahbari NN, Garden OJ, Padbury R, Maddern G, Koch M, Hugh TJ, et al. 2011; Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford). 13:528–535. DOI: 10.1111/j.1477-2574.2011.00319.x. PMID: 21762295. PMCID: PMC3163274.

2. Angelico R, Siragusa L, Serenari M, Scalera I, Kauffman E, Lai Q, et al. Italian Chapter of IHPBA (AICEP, Associazione Italiana di Chirurgia Epatobilio-Pancreatica). Rescue liver transplantation after post-hepatectomy acute liver failure: a systematic review and pooled analysis. Transplant Rev (Orlando). 2023; 37:100773. DOI: 10.1016/j.trre.2023.100773. PMID: 37356212.

3. Kim DS, Yoon YI, Kim BK, Choudhury A, Kulkarni A, Park JY, et al. for Asian Pacific Association for Study of Liver (APASL). Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation. Hepatol Int. 2024; 18:299–383. DOI: 10.1007/s12072-023-10629-3. PMID: 38416312.

4. Shingina A, Mukhtar N, Wakim-Fleming J, Alqahtani S, Wong RJ, Limketkai BN, et al. 2023; Acute liver failure guidelines. Am J Gastroenterol. 118:1128–1153. DOI: 10.14309/ajg.0000000000002340. PMID: 37377263.

5. Singh SA, Singh A, Pamecha V, Pandey CK, Sarin SK. 2017; Living donor liver transplantation for acute liver failure with fixed pupils: are we fixed? J Clin Exp Hepatol. 7:155–157. DOI: 10.1016/j.jceh.2016.09.014. PMID: 28663681. PMCID: PMC5478968.

6. Thomas PD. 2000; The differential diagnosis of fixed dilated pupils: a case report and review. Crit Care Resusc. 2:34–37. DOI: 10.1016/S1441-2772(23)02120-8. PMID: 16597282.