Published online Feb 7, 2016. doi: 10.3748/wjg.v22.i5.1919
Peer-review started: July 13, 2015
First decision: August 26, 2015
Revised: September 11, 2015
Accepted: November 9, 2015
Article in press: November 9, 2015
Published online: February 7, 2016
Processing time: 195 Days and 0.3 Hours
Acute liver failure (ALF) is a reversible disorder that is associated with an abrupt loss of hepatic mass, rapidly progressive encephalopathy and devastating complications. Despite its high mortality, an emergency liver transplantation nowadays forms an integral part in ALF management and has substantially improved the outcomes of ALF. Here, we report the case of a 32-year-old female patient who was admitted with grade IV hepatic encephalopathy (coma) following drug-induced ALF. We performed an emergency auxiliary partial orthotopic liver transplantation with a “high risk” graft (liver macrovesicular steatosis approximately 40%) from a living donor. The patient was discharged on postoperative day 57 with normal liver function. Weaning from immunosuppression was achieved 9 mo after transplantation. A follow-up using CT scan showed a remarkable increase in native liver volume and gradual loss of the graft. More than 6 years after the transplantation, the female now has a 4-year-old child and has returned to work full-time without any neurological sequelae.
Core tip: The use of a “high risk” organ (i.e., steatosis graft) bears the risk of poor graft and patient survival. It is commonly recommended to use marginal and steatotic grafts in recipients who are in a relatively good clinical condition (i.e., MELD scores < 20) and avoid using them for fulminant or end-stage liver failure. In the presented case of a young female with acute liver failure, the use of a “high risk” graft (partial liver with approximately 40% macrovesicular steatosis) resulted in an excellent short and long term outcome. She survived immunosuppression weaning without any neurological sequelae after the auxiliary partial orthotopic liver transplantation.