Liver derived pro-inflammatory cytokines may be important in producing intracranial hypertension in acute liver failure.
We describe a patient with paracetamol induced acute liver failure (ALF) who fulfilled criteria for poor prognosis and was waiting for a liver to become available for transplantation. Because of severe uncontrolled intracranial hypertension she underwent a hepatectomy that resulted in stabilization of her systemic and cerebral hemodynamics. She remained anhepatic for 14 h and was successfully bridged to liver transplantation. The removal of the liver was associated with a sharp and sustained reduction in the circulating pro-inflammatory cytokine concentration suggesting that liver derived pro-inflammatory cytokines may be important in the pathogenesis of intracranial hypertension in patients with ALF.
Jalan
Rajiv
R
Institute of Hepatology, University College London Medical School, 69-75 Chenies Mews London WC1E 6HX, UK. r.jalan@ucl.ac.uk
Pollok
Anthony
A
Shah
Syed H A
SH
Madhavan
Krishna
K
Simpson
Kenneth J
KJ
D000082:Acetaminophen / Q000506:poisoning; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000506:poisoning; D016207:Cytokines / Q000276:immunology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology / Q000276:immunology*; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000276:immunology* / Q000601:surgery; D016031:Liver Transplantation
D018712:Analgesics, Non-Narcotic; D016207:Cytokines; D000082:Acetaminophen