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Abstract

Wilson disease is a genetic disease involving copper metabolism disturbances that result in copper accumulations, especially in the liver and brain. Wilson disease can be treated with pharmacologic agents, such as chelators that induce urinary excretion of copper or zinc salts that inhibit copper absorption in the digestive tract. Liver transplant is the only treatment option for Wilson disease when liver failure has occurred. In some patients, that is, in those with Child-Pugh A score, neurologic disease can be seen without hepatic failure. Our recommendation is for these patients to have auxiliary partial orthotopic liver transplant. Here, we present a 36-year-old male patient with neurologic disease associated with Wilson disease who had successful related living-donor auxiliary partial orthotopic liver transplant using a left lobe. The patient, as a result of neurologic symptoms that included tremor walking and speaking problems and low serum ceruloplasmin level of 7 mg/dL, was diagnosed with Wilson disease, and a liver biopsy was performed. Chronic necroinflammatory disease activity was 4/18, and the patient received chelation treatment. His hepatic functions were normal. The donor was the patient's 57-year-old father whose liver function tests were also normal. The graft-to-recipient weight ratio was 1% using a left lobe graft. After transplant, serum ceruloplasmin levels on day 15 and month 1 were 14 and 19 mg/dL. At month 1, liver function tests were normal. Doppler ultrasonography showed normal vascular flow of the native liver and the graft. The patient's neurologic symptoms were progressively reduced. Progressive neurologic deterioration with no hepatic insufficiency is considered a suitable indication for auxiliary partial orthotopic liver transplant; this procedure is suggested before the neurologic and liver failure symptoms of Wilson disease occur.

Liver transplantation for hypoparathyroidism secondary to Wilson's disease

“…Specifically, CP levels have been reported to show a time-dependent increase after liver transplant in patients with WD. [5] In the case report, CP recovered to 39.1 mg/dL at 3 weeks post-transplant, which was remarkably increased as compared to that of the 17.1 mg/dL recorded prior to surgery.…”

Pediatric metabolic liver diseases: Evolving role of liver transplantation

“…The role of APOLT in MLDs is to provide the defective enzymes, and it has shown excellent results for selected metabolic indications such as CNS, PA, and UCD[ 5 , 103 , 104 ]. Rarely has it been done for WD with a normal liver and neurological dysfunction[ 105 ]. The authors have one of the largest experiences of performing APOLT in non-cirrhotic MLDs till date where the post LT outcome was comparable to OLT[ 5 ].…”