title: Control of cerebral oedema by total hepatectomy and extracorporeal liver support in fulminant hepatic failure.
abstract: 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.
authors.affiliation: Liver Support Unit, Cedars-Sinai Medical Center, Los Angeles, California 90048-1865.
authors.forename: J
authors.initials: J
authors.lastname: Rozga
authors.forename: L
authors.initials: L
authors.lastname: Podesta
authors.forename: E
authors.initials: E
authors.lastname: LePage
authors.forename: A
authors.initials: A
authors.lastname: Hoffman
authors.forename: E
authors.initials: E
authors.lastname: Morsiani
authors.forename: L
authors.initials: L
authors.lastname: Sher
authors.forename: G M
authors.initials: GM
authors.lastname: Woolf
authors.forename: L
authors.initials: L
authors.lastname: Makowka
authors.forename: A A
authors.initials: AA
authors.lastname: Demetriou
mesh_terms: 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