Fatal neurological complication after liver transplantation in acute hepatic failure patient with hepatic encephalopathy.
- Author:
Joo Yun KIM
1
;
Hyun Su RI
;
Ji Uk YOON
;
Eun Ji CHOI
;
Hye Jin KIM
;
Ju Yeon PARK
Author Information
- Publication Type:Case Report
- Keywords: Acute Hepatic Failure; Brain edema; Hepatic encephalopathy; Liver Transplantation; Seizure
- MeSH: Adult; Ammonia; Atrophy; Brain; Brain Edema; Cerebral Hemorrhage; Cerebral Infarction; Consciousness; Hepatic Encephalopathy*; Humans; Liver Diseases; Liver Failure; Liver Failure, Acute*; Liver Transplantation*; Liver*; Mortality; Muscle, Smooth; Pupil; Reflex; Seizures; Tissue Donors
- From:Kosin Medical Journal 2018;33(1):96-104
- CountryRepublic of Korea
- Language:English
- 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.
