title: Long-term survival after 66 hours of anhepatic time with no neurological deficit.
abstract: BACKGROUND
  Intractable intraoperative hemorrhage is a rare complication of liver transplantation. Rescue hepatectomy with portocaval shunting can be used as a bridging procedure until a new organ donor becomes available. During the anhepatic period, however, there is a substantial risk of developing end-organ damage, the brain being particularly susceptible to insult.
  
  
  METHODS
  A 66-year-old male underwent liver transplantation due to non-alcoholic steatotic hepatitis and hepatocellular carcinoma. The transplantation was complicated by perioperative intractable bleeding. Despite attempts to control the bleeding, the patient became hemodynamically unstable and a rescue hepatectomy with portocaval shunting was performed. The patient remained anhepatic for 66 hours in an intensive care unit until a second donor organ was found. He made a good recovery and had no neurological deficit.
  
  
  CONCLUSIONS
  Rescue hepatectomy with portocaval shunting is a viable short-term solution until a suitable donor organ is found. During this period, inotrope infusion and continuous veno-venous hemofiltration within an intensive care unit setting can be used as supportive measures. Nevertheless, a prolonged anhepatic time increases the risk of multiple organ failure and should be kept to a minimum due to metabolic disturbance and the build-up of toxic metabolites.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Photi
authors.affiliation: Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Crawford
authors.affiliation: Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pulitano
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011170:Portasystemic Shunt, Surgical; D017741:Survivors; D013997:Time Factors; D014019:Tissue Donors