Control of cerebral oedema by total hepatectomy and extracorporeal liver support in fulminant hepatic failure.
Keeping a patient with fulminant hepatic failure (FHF) alive until a donor liver is available for transplantation can be a problem. We describe an 18-year-old woman with paracetamol-induced FHF, who was treated by total hepatectomy, hypothermia, plasma exchange, and extracorporeal liver support. The patient was anhepatic for 14 h. The liver-support system consisted of plasma separation and perfusion through a charcoal filter and a hollow-fibre module seeded with matrix-attached porcine hepatocytes. With artificial liver treatment there was reversal of severe neurological dysfunction, normalisation of intracranial pressure, and decreased serum ammonia. The patient underwent emergency transplantation with an ABO-incompatible liver, followed by transplantation with a compatible organ eight days later. The patient has fully recovered and is neurologically intact.
Rozga
J
J
Liver Support Unit, Cedars-Sinai Medical Center, Los Angeles, California 90048-1865.
Podesta
L
L
LePage
E
E
Hoffman
A
A
Morsiani
E
E
Sher
L
L
Woolf
G M
GM
Makowka
L
L
Demetriou
A A
AA
D000293:Adolescent; D001187:Artificial Organs; D001929:Brain Edema / Q000209:etiology / Q000628:therapy*; D005260:Female; D006498:Hepatectomy; D006501:Hepatic Encephalopathy / Q000150:complications / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation