Long-term survival after 67 hours of anhepatic state due to primary liver allograft nonfunction

Abstract

Primary liver allograft nonfunction immediately after transplantation poses a life-threatening situation for the recipient. Emergency retransplantation may not be immediately possible due to organ unavailability. Total hepatectomy with temporary portacaval shunt has been described as a bridge to retransplantation when the presence of the graft appears to be harming the recipient. Case reports of retransplantation after total hepatectomy with anhepatic times greater than 48 hours routinely describe poor outcomes. We present a case with excellent patient outcome after 95 hours of clinical anhepatic state, including 67 hours of anatomical anhepatic time, because of primary liver allograft nonfunction. This case report documents the longest anhepatic time with subsequent successful transplant

Liver Transplantation for Hepatic Trauma

“…Introduced by Ringe et al 57 more than 2 decades ago, its use has been reported under such circumstances, also in nontrauma patients developing hemodynamic instability with the longest anhepatic time of 67 hours. [58][59][60] Notably, a nonsignificant increase in 90-day risk of graft loss after 2-stage transplantations was found in the present study. Although a lack of significance with respect to the risk of graft loss may be related to a low number of patients undergoing 2-stage operations, this is not the case for postoperative mortality, which was identical after 1-and 2-stage operations.…”

Utilization and outcomes of rescue hepatectomy among U.S. liver retransplant candidates

“…Indications for rescue hepatectomy include post‐transplant complications, fulminant native hepatic failure, and liver trauma, among others 17,20–24 . Previous studies have shown that among transplant recipients, anhepatic patients experience high mortality 3–5,11 . The utilization of rescue hepatectomy and anhepatic status in the United States has not been studied and, to our knowledge, this is the first analysis of the national experience of this practice as a bridge to liver retransplantation.…”

“…The anhepatic patient requires astute anesthetic and critical care management with attention to electrolyte balance, body temperature, coagulopathy, renal function, with the potential for cerebral edema 8–10 . Anhepatic patients can experience high mortality without timely retransplantation, so the intent of rescue hepatectomy and retransplantation as two stages are to stabilize and salvage a patient 11 . An allograft is often not always immediately available placing the patient in a vulnerable position 12 .…”

The 2-Stage Liver Transplant: 3 Clinical Scenarios

“…Arora and coworkers reported anatomic anhepatic time 67 hours for a patient with primary nonfunction, and this is the longest anhepatic time in the literature. 10 Anhepatic times < 30 hours are well tolerated. 5 There are several problems during the anhepatic period, and patients require maximal intensive care.…”