演題

IS-3-1

Liver transplantation in acute liver failure: The Istanbul Faculty of Medicine experience

[演者] İlgin Özden:1
1:Istanbul Faculty of Medicine, Turkey

Objective: To analyze the current results of transplantation in acute liver failure at the Istanbul Faculty of Medicine.Patients and methods: The charts of the 35 patients (median (range) age: 15(2-62) years) who underwent liver transplantation for acute liver failure between 2008-June 2014 were evaluated retrospectively. Results: The etiologic factors were toxic agents (8; mushrooms 6, herbal tea 2), viruses (7), Wilson’s disease (4), autoimmune hepatitis (3) and fulminant Budd-Chiari syndrome (2); 10 cases were cryptogenic. Organs from cadaveric donors were transplanted to 28 patients (including 3 left lateral sections from split livers, 1 from a reduced liver); 7 patients underwent living donor transplantation (4 right lobes and 3 left lateral sections). One patient (3 %) died of multiple organ failure, with a functioning graft on the second postoperative day. Bacterial infection was the most common complication (25/34; 74 %), followed by postoperative delirium (4/34; 12%) and severe acute rejection (2/34; 6 %). Acute renal failure, thrombotic thrombocytopenic purpura, tracheal stenosis due to prolonged intubation, nonanastomotic hepatic artery stenosis due to kinking, recurrent autoimmune hepatitis, stricture of the choledochocholedochostomy, refractory massive pleurisy and chronic rejection occurred in one patient each. Two patients died of pneumonia and fungal infection on the 14th and 18th postoperative months. Overall survival was 32/35 (91%).Conclusions: Improved cadaveric organ sharing, use of split grafts when possible, and transplantation from living donors in appropriate situations yield a high survival rate, despite high early morbidity, in acute liver failure patients whose conditions deteriorate despite intensive care treatment.
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