Liver Transplants for Alcoholic Liver Disease

Fingerote, RJ; Bain, Vincent G.; Fedorak, R

doi:10.1155/1991/567452

Cited by 1 publication

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“…Acute liver failure can affect patients without known pre-existing liver disease [4,6,13,14,211 and results in mortality rates of between 40 % and 85 %, as generally reported [23, 301. The most important causes of acute liver failure are the hepatitis B and C viruses [2,18,29,33,341.…”

Section: Introductionmentioning

confidence: 99%

Relevance of two-stage total hepatectomy and liver transplantation in acute liver failure and severe liver-trauma

Fernández

Lange²,

Länge³

et al. 2001

Transplant Int

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Emergency liver transplantation frequently is the only lifesaving procedure in cases of acute liver failure. It remains unclear whether emergency hepatectomy with portocaval shunt followed by liver transplantation as a two-stage procedure should be performed in cases in which a donor organ is not yet available. It has been stated that "toxic liver syndrome" could be treated by means of this strategy. From 1990 to 1995 we performed emergency hepatectomies in eight cases of acute liver failure or traumatic liver rupture with exsanguinating bleeding. In six cases we were able to perform a subsequent liver transplantation. Five of the six patients who underwent an emergency hepatectomy died. Emergency hepatectomy led to a significant increase in epinephrine dosage until the transplantation was performed. Only after transplantation did the need for epinephrine therapy decrease. The need for oxygen support did not change during the entire observation period. Plasmatic coagulation was stabilized by substitution, showing significantly higher values at 24 h after transplantation than at 48 h before transplantation. Fibrinogen increased significantly after transplantation in this group of patients. The experiences gathered at our clinic, however, do not show advantages that would allow a recommendation of emergency hepatectomy and subsequent liver transplantation as a two-stage procedure except for situations of severe and uncontrollable hepatic bleeding. Considering the progressive destabilization of our patients, fast procurement of donor organs seems to be of imminent importance for the outcome.

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