Can Patients Who Develop Cerebral Death in Fulminant Liver Failure Despite Liver Transplantation Be Previously Forseen?
BACKGROUND
The outcome of medical treatment is worse in fulminant liver failure (FLF) developing on acute or chronic ground. Recently, liver transplantations with the use of living and cadaveric donors have been performed in these diseases and good results obtained. In this study, we aimed to present the factors affecting the recovery of cerebral functions after liver transplantation in hepatic encephalopathy (HE) developing in FLF, to identify irreversible patient groups and to prevent unnecessary liver transplantation.


METHODS
In Inonu University's Liver Transplant Institute, 69 patients who made an emergency notice to the National Coordination Center for liver transplantation owing to FLF from January 2012 to December 2015 were included in the study. Patients were divided into 2 groups. Group 1 consisted of 52 patients who underwent liver transplantation and recovered normal brain function, and group 2 had 17 patients who underwent liver transplantation and did not recover normal brain function and had cerebral death. All patients were evaluated before surgery for clinical encephalopathy stage, light reflex, and convulsions. Groups were compared and assessed according to age (>40, 10-40 and <10 years), body mass index, etiologic factor, preoperative laboratory values, transplantation type, mortality, and encephalopathy level. Multivariate analysis was done for specific parameters.


RESULTS
Prothrombin time (PT), international normalized ratio (INR), and total bilirubin values were significantly different between the groups. There was no significant difference between the groups regarding ammonia and lactate levels. There was a statistically significant difference between the groups regarding sodium and potassium levels from serum electrolytes. However, the averages of both groups were within normal limits. pH and total bilirubin levels were meaningful for multivariate analysis.


CONCLUSIONS
HE reversibility, mortality, and morbidity are important in patients with HE who undergo liver transplantation. Therefore, West Haven clinical staging and serum INR, PT, and total bilirubin level may be helpful in predicting the reversibility of FLF patients with HE before liver transplantation. It was determined that West Haven encephalopathy grading is important in determining the reversibility of HE after transplantation in FLF; especially the probability of reversibility of stage 4 HE decreases significantly. High PT and INR levels, hyperbilirubinemia, and serum sodium and potassium concentrations were risk factors for the reversibility of HE in this study.
Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey. Electronic address: kemalbarissarici@mynet.com.
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Sarici
Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey.
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Karakas
Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey.
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Otan
Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey.
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Ince
Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey.
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Koc
Department of Surgery, Antalya Training and Research Hospital, Antalya, Turkey.
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Koc
Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey.
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Bayraktar
Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey.
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Aydin
Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey.
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Kayaalp
Department of Pediatric Neurology, Inonu University Faculty of Medicine, Malatya, Turkey.
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Gungor
Department of Neurology, Inonu University Faculty of Medicine, Malatya, Turkey.
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Kablan
Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey.
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Yilmaz
D000293:Adolescent; D000328:Adult; D000368:Aged; D000641:Ammonia / Q000378:metabolism; D001663:Bilirubin / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D001926:Brain Death; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019934:International Normalized Ratio; D017114:Liver Failure, Acute / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D011517:Prothrombin Time; D012307:Risk Factors; D055815:Young Adult
D015415:Biomarkers; D000641:Ammonia; D001663:Bilirubin