PurposeOccasionally, single ventricle (SV) patients survive into adulthood without Fontan palliation; with the theoretical advantage of potentially lower inferior caval vein pressures. We studied liver and renal function in an adult cohort of SV patients who had not undergone Fontan completion (F-) and a group who had Fontan completion (F+) in adult life.MethodsRetrospective case note analysis between 1990–2017.ResultsThere were 12 SV patients in the F- group [9 (75%) male, age 41 years (18–52), 8 (67%) had previous surgery, aortopulmonary shunt: 3, Glenn: 5]. Outcomes: 2 deaths (at 42 and 24 years), 1 assessed for transplant, 2 for TCPC completion, 7 balanced circulations. At last review, saturations were 78% (69–85), Hb 192 g/L (159–252), creatinine 88 μmol/L (59–129), eGFR 65 (59– >90), albumin 46 g/L (35–50), bilirubin 20 μmol/L (12–46) and platelets 220 (105–333). Abdominal USS was available in 5: normal liver (2), mild-moderate fibrosis (2), cirrhosis (1).There were 8 SV patients in the F+ group, [3 (37%) male, age 46 years (23–55), age at Fontan completion 28 years (16–46)]. Follow-up was 13 years (2–24).Outcomes1 transplant, 4 failing Fontan physiology, 3 well. At last review, saturations were 95% (75–96), Hb 163 g/L (108–171), creatinine 76 μmol/L (66–148), eGFR 72 (36– >90), albumin 47 g/L (30–52), bilirubin 13 μmol/L (10–39) and platelets 216 (137–429). Abdominal USS was available in 5: normal liver (2), mild-moderate fibrosis (2), severe fibrosis (1).ConclusionIn both groups, synthetic liver function was preserved and a minority showed advanced fibrosis/cirrhosis on USS. Renal function was impaired, more prominently in the non-Fontan group, likely reflecting the effect of chronic hypoxia. Strategies to delay or avoid Fontan completion may not preserve liver function.

Abstract:Acute liver failure (ALF) is a severe condition leading to fatal complications and death. Early detection and proper management can save life. The aim of the study was to analyze different biochemical values in acute liver failure and its relation with outcome. This study was conducted over 64 admitted patients in two medical college hospitals for duration of one and half year from December 2013 to May 2015. At presentation S. bilirubin level was in the range of 5-20 mg/dl in 46 (71.88%), S. ALT level in the range of 100 -500 U/L in 46 (71.88%) and prothrombin time more than 22 seconds in 40 (62.50%) patients. Among other biochemical values S. creatinine was >1.5 mg/dl in 14 (21.88%), random blood glucose level < 2.5 mg/dl in 12 (18.75%) and hyponatremia in 20 (43.48%) patients. Majority (56.25%) of patients were HEV positive. Mortality was 100% in patients with S. bilirubin, S.ALT or prothrombin time level >10 mg/dl, >500 U/L and >21 seconds respectively at presentation. The higher the liver biochemical values the higher is the mortality rate. More multicentre study with large sample size is recommended to make a concrete comment.