Living donor liver transplantation for pediatric acute liver failure and prolonged hepatic encephalopathy: A case report
DOI:
https://doi.org/10.69926/ldlt2025Abstract
Abstract:
Background:
Liver transplantation (LT) is the definitive treatment for selected patients with acute liver failure (ALF). Diffuse cerebral edema is a relative contraindication and associated with poor outcomes after LT. There is very limited literature on outcomes of pediatric ALF in the setting of prolonged grade 4 hepatic encephalopathy and diffuse cerebral edema.
Case presentation:
Here, we report 2-year follow-up in a 7 year old girl with hepatitis A induced ALF. At the time of transplant, there was hepatic coma and diffuse brain edema necessitating mechanical ventilation, multiple episodes of seizures, and subdural hematomas on imaging. Due to donor issues, liver transplant was performed after 72 hours of initial presentation. There was delayed extubation and the post-operative course was complicated by neurocognitive impairment. At the time of discharge, there was impaired swallowing, speech, and mobility. Extensive home based rehabilitation with percutaneous endoscopic gastrostomy feeding was required. The child made gradual recovery, and two years after transplant, meets majority of the developmental criteria for age.
Conclusion:
Although Liver transplant was once considered an absolute contraindication to diffuse brain edema in ALF but with meticulous perioperative care acceptable results can be achieved.
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