Emergent orthotopic liver transplantation for subfulminant hepatic failure: A case report

Finding a timely donor liver for patients with fulminant or subfulminant hepatic failure is very difficult in Taiwan. We report the case of a patient with hepatitis B related cirrhosis who underwent emergency liver transplantation following progressive neurological deterioration. The patient, a 26-year old male, had been diagnosed as having a hepatitis B infection 7 years before surgery. He had no follow-up until his admission to our hospital where he was found to have cirrhosis of the liver combined with acute hepatitis. Hepatitis marker study disclosed HBsAg (+), anti-HCV (-), and HBeAg(-). The patient's family refused interferon therapy. The patient became semicomatose within 10 days of admission. Total bilirubin level was markedly elevated at 35 mg/dl and prothrombin time was prolonged (International normalized ratio = 4.0). Fortunately, a donor with the same blood type was available and emergency orthotopic liver transplantation was performed two weeks after admission. We gave hepatitis B immunoglobulin (HBIG) 100 ml during the anhepatic phase and another 100 ml on the first postoperative day. We also perscribed the antiviral agent lamivudine 100 mg once preoperatively and 100 mg every day postoperatively for one year. Immunosuppressive agents mainly consisted of standard doses of cyclosporine, azathioprine and steroid. The patient recovered quickly and was discharged one month postoperatively with normal liver function and negative hepatitis B antigen.