Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hematol. Feb 6, 2017; 6(1): 24-27
Published online Feb 6, 2017. doi: 10.5315/wjh.v6.i1.24
Role of plasmapheresis in early allograft dysfunction following deceased donor liver transplantation
Ashwin Rammohan, Deepti Sachan, Satish Logidasan, Jeswanth Sathyanesan, Ravichandran Palaniappan, Mohamed Rela
Ashwin Rammohan, Deepti Sachan, Mohamed Rela, Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai 600100, India
Satish Logidasan, Jeswanth Sathyanesan, Ravichandran Palaniappan, Institute of Surgical Gastroenterology and Liver Transplantation, Govt Stanley Medical College Hospital, Chennai 600001, India
Mohamed Rela, Institute of Liver Studies, King’s College Hospital, London, SE5 9RS, United Kingdom
Author contributions: All the authors contributed to the manuscript.
Institutional review board statement: Approval for this case report was obtained from the Institutional review board.
Informed consent statement: All involved persons (subjects or legally authorized representative) gave their informed consent (written or verbal, as appropriate) prior to study inclusion.
Conflict-of-interest statement: The above doctors have no conflicts of interest or financial ties to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ashwin Rammohan, FRCS, Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Cheran Nagar, Chennai 600100, India. ashwinrammohan@gmail.com
Telephone: +91-98-84173583 Fax: +91-44-24570439
Received: August 9, 2016
Peer-review started: August 10, 2016
First decision: September 12, 2016
Revised: September 25, 2016
Accepted: November 16, 2016
Article in press: November 16, 2016
Published online: February 6, 2017
Processing time: 163 Days and 3.8 Hours
Abstract

The role of plasmapheresis in liver failure and hepatic encephalopathy is undefined and its use as a strategy to salvage patients with severe allograft dysfunction after liver transplantation remains investigational. We present a case of early allograft dysfunction following deceased donor liver transplantation (DDLT) where plasmapheresis was effective as a bridge to recovery and possibly avoiding a retransplantation. A 16 years old boy, known to have decompensated Wilson’s disease underwent DDLT at our Public Sector Hospital. He received a healthy liver from a brain-dead donor, whose liver was considered too large for the boy. The graft was reduced in situ to a left lobe graft. Surgery was uneventful and the recipient was well for the initial 96 h. On Doppler and further computed tomography scan, a partial portal vein thrombus was noted. He was reexplored and a Fogarty endothombecteomy was performed. Following the second surgery, he developed severe allograft dysfunction with a peak bilirubin of 40 mg/dL. He underwent imaging to rule out technical causes for the dysfunction, followed by a liver biopsy, which revealed acute cellular rejection. Multiple cycles of plasmapheresis were initiated. Over the next two weeks, the graft demonstrated a gradual recovery. He was discharged on the 30th postoperative day, with a serum bilirubin of 5.5 mg/dL. He remains well on follow-up, with the liver function tests improving further. Our report demonstrates the beneficial effect of plasmapheresis, which appears to be an effective treatment option for early allograft dysfunction following liver transplantation and may obviate the need for retransplantation.

Keywords: Liver transplantation; Allograft dysfunction; Plasmapheresis

Core tip: We demonstrate the beneficial effects of plasmapheresis, which appears to be an effective treatment option for early allograft dysfunction following liver transplantation and may obviate the need for retransplantation.