Septic shock after liver transplantation for Caroli's disease: clinical improvement after treatment with C1-esterase inhibitor.
The extent of complement and contact activation is related to outcome in sepsis. A low functional index of their main blocker C1-esterase inhibitor (C1-INH) is considered as a relative deficiency of C1-INH and might contribute to the development of fatal complications in the intensive care unit. The first results of therapeutic intervention with C1-INH concentrate in septic shock are promising. We report on our experience of C1-INH concentrate administration in a young woman with Caroli's disease as ultimate rescue therapy for septic shock with capillary leakage syndrome after combined liver and kidney transplantation. No focus of infection was detectable and thus surgical intervention was not indicated. Antibiotic therapy at that time included vancomycin, tobramycin, meropenem and fluconazol. Hemodynamic stabilization occurred within hours after administration of C1-INH concentrate. Simultaneously a reduction in vasopressor medication was possible and negative fluid balance was achieved.
Marx
G
G
Department of Anaesthesiology, Hannover Medical School, Carl-Neuberg Strasse 1, D-30 625 Hannover, Germany. marx.gernot@mh-hannover.de
Nashan
B
B
Cobas Meyer
M
M
Vangerow
B
B
Schlitt
H J
HJ
Ziesing
S
S
Leuwer
M
M
Piepenbrock
S
S
Rueckoldt
H
H
D000328:Adult; D016767:Caroli Disease / Q000150:complications* / Q000601:surgery; D003174:Complement C1 Inactivator Proteins / Q000008:administration & dosage*; D016984:Enterococcus faecium; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology; D016879:Salvage Therapy / Q000379:methods; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology
D003174:Complement C1 Inactivator Proteins