Fatal neurological complication after liver transplantation in acute hepatic failure patient with hepatic encephalopathy

Article information

Kosin Med J. 2018;33(1):96-104

Publication date (electronic) : 2018 January 21

doi : https://doi.org/10.7180/kmj.2018.33.1.96

Joo-Yun Kim , Hyun-Su Ri , Ji-Uk Yoon , Eun-Ji Choi , Hye-Jin Kim , Ju-Yeon Park

Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea

Corresponding Author: Hyun-Su Ri, Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 50612 Mulgeurn-eup, Yangsan-si, Korea Tel: +82-55-360-2129 Fax: +82-55-360-2149 E-mail: johnri@naver.com

Received 2017 October 10; 2017 November 13; Accepted 2017 November 16.

Abstract

Liver transplantation is a current definitive treatment for those with end-stage liver disease. Hepatic encephalopathy is a common complication of hepatic failure, which can be improved and aggravated by various causes. It is important to differentiate hepatic encephalopathy from other diseases causing brain dysfunction such as cerebral hemorrhage, which is also related to high mortality after liver transplant surgery. A 37-year-old patient was presented with acute liver failure and high ammonia levels and seizure-like symptoms. Computed tomography (CT) of his brain showed mild brain atrophy, regarded as a symptom of hepatic encephalopathy, and treated to decrease blood ammonia level. Deceased donor liver transplantation was performed and liver function and ammonia level normalized after surgery, but the patient showed symptoms of involuntary muscle contraction and showed loss of pupil reflex and fixation without recovery of consciousness. Brain CT showed brain edema and bilateral cerebral infarction, and the patient died after a few days. The purpose of this case report is to emphasize the importance of preoperative neurological evaluation, careful transplantation decision, and proper perioperative management of liver transplantation in patients with acute hepatic encephalopathy.

Keywords: Acute Hepatic Failure; Brain edema; Hepatic encephalopathy; Liver Transplantation; Seizure

Fig. 1.

Brain CT was performed on the day before surgery when the consciousness was semi-coma. As a results of reading, no specific finding was observed other than mild brain atrophy.

Fig. 2.

On the first day after surgery, brain CT revealed severe cerebral edema and cerebral infarction. At this time, the patient showed bilateral pupil dilatation and fixation without recovery of consciousness.

Table 1.

Perioperative clinical laboratory findings

Table 2.

Perioperative vital signs

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