title: Living related liver transplantation for acute fulminant hepatitis B: experience from two possible hyper-acute cases.
abstract: Fulminant hepatic failure, which is represented by fulminant hepatitis, is fatal in most cases unless prompt liver transplantation is performed. Even if liver transplantation is performed, irreversible neurological damage is often complicated. In this case report, we describe two cases of fulminant hepatitis induced by acute hepatitis B virus infection, both of which were successfully rescued by living related liver transplantation without significant complications. The case 1 was a 45-year-old Japanese male. He complained general malaise and anorexia. His local physician diagnosed him as acute hepatitis B, and referred to our hospital. Due to severe coagulopathy, plasma exchange was performed 3 times. However, his hepatic coma progressed rapidly along with rapid decrease of both his direct/indirect bilirubin (D/T) ratio and serum blood urea nitrogen (BUN) levels. Living related liver transplantation was performed under the diagnosis of acute fulminant hepatitis B. The case 2 was a 34-year-old Japanese male. His complaints were fever and skin rush. He was referred to our hospital under the diagnosis of acute hepatitis B. On the second day after admission, he developed grade II hepatic coma, which deteriorated into grade III in spite of intensive therapy including plasma exchange. He also demonstrated rapid decrease of both D/T ratio and serum BUN level. Living related liver transplantation was performed on the next day. Both cases recovered without any evidence of neurological sequelae. In general, it is extremely difficult to rescue fulminant hepatitis by conservative treatments, particularly in cases with rapid progression. Although emergency liver transplantation may be an only option to rescue in such a case, living related liver transplantation has an advantage in view of urgent organ donation over cadeveric transplantation.
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Inoue
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ueno
authors.forename: Noriatsu
authors.initials: N
authors.lastname: Kanno
authors.forename: Hideaki
authors.initials: H
authors.lastname: Anzai
authors.forename: Yasuteru
authors.initials: Y
authors.lastname: Kondo
authors.forename: Yuki
authors.initials: Y
authors.lastname: Moritoki
authors.forename: Emiko
authors.initials: E
authors.lastname: Mikami
authors.forename: Masanori
authors.initials: M
authors.lastname: Chiba
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kogure
authors.forename: Futoshi
authors.initials: F
authors.lastname: Nagasaki
authors.forename: Koji
authors.initials: K
authors.lastname: Fukushima
authors.forename: Takao
authors.initials: T
authors.lastname: Iwasaki
authors.forename: Susumu
authors.initials: S
authors.lastname: Satomi
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D000208:Acute Disease; D000328:Adult; D017408:Guidelines as Topic; D006509:Hepatitis B / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood / Q000473:pathology* / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed