Liver transplantation results in complete neurologic recovery from malignant hypertension secondary to fulminant hepatic failure: a case report
Uncontrolled intracranial hypertension can lead to cerebral herniation and death in patients with acute liver failure. A 26-year-old female was admitted for acute liver failure following inadvertent acetaminophen overdose. The pH on admission was 6.9. Her neurologic status precipitously deteriorated...
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| Veröffentlicht in: | Annals of transplantation 2012-01, Vol.17 (1), p.117-121 |
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| container_title | Annals of transplantation |
| container_volume | 17 |
| creator | Tsoulfas, Georgios Elias, Nahel Sandberg, Warren S Ko, Dicken S C Kawai, Tatsuo Cosimi, A Benedict Tsitsopoulos, Parmenion P Agorastou, Polyxeni Hertl, Martin |
| description | Uncontrolled intracranial hypertension can lead to cerebral herniation and death in patients with acute liver failure.
A 26-year-old female was admitted for acute liver failure following inadvertent acetaminophen overdose. The pH on admission was 6.9. Her neurologic status precipitously deteriorated and she was listed for liver transplantation. An intracranial pressure (ICP) monitoring catheter was inserted, which revealed a pressure >60 mmHg. After neurointensive care treatment, ICP was lowered and an emergency left lobe living donor liver transplant was performed. Intraoperative management of the ICP, which rose to 80 mmHg during the explant phase, was achieved by therapy with barbiturates and hypothermia. After surgery, hepatic function improved initially, but 7 days post transplantation the graft showed signs of acute failure. The pathology report of a liver biopsy suggested acute rejection and liver retransplantation using a deceased donor liver was then carried out. The postoperative course was uneventful and the patient recovered completely without any residual neurologic deficits.
This case states that favourable outcomes can result from sub-optimal starting points, and that the human brain has the ability to overcome extremely adverse conditions. Critical in this effort is the role of proper neuromonitoring which helps implement the appropriate treatment measures. |
| doi_str_mv | 10.12659/AOT.882644 |
| format | Article |
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A 26-year-old female was admitted for acute liver failure following inadvertent acetaminophen overdose. The pH on admission was 6.9. Her neurologic status precipitously deteriorated and she was listed for liver transplantation. An intracranial pressure (ICP) monitoring catheter was inserted, which revealed a pressure >60 mmHg. After neurointensive care treatment, ICP was lowered and an emergency left lobe living donor liver transplant was performed. Intraoperative management of the ICP, which rose to 80 mmHg during the explant phase, was achieved by therapy with barbiturates and hypothermia. After surgery, hepatic function improved initially, but 7 days post transplantation the graft showed signs of acute failure. The pathology report of a liver biopsy suggested acute rejection and liver retransplantation using a deceased donor liver was then carried out. The postoperative course was uneventful and the patient recovered completely without any residual neurologic deficits.
This case states that favourable outcomes can result from sub-optimal starting points, and that the human brain has the ability to overcome extremely adverse conditions. Critical in this effort is the role of proper neuromonitoring which helps implement the appropriate treatment measures.</description><identifier>ISSN: 1425-9524</identifier><identifier>EISSN: 2329-0358</identifier><identifier>DOI: 10.12659/AOT.882644</identifier><identifier>PMID: 22466917</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Female ; Hepatic Encephalopathy - complications ; Hepatic Encephalopathy - surgery ; Humans ; Hypertension, Malignant - etiology ; Hypertension, Malignant - physiopathology ; Hypertension, Malignant - surgery ; Intracranial Hypertension - complications ; Intracranial Hypertension - surgery ; Intracranial Pressure ; Liver Failure, Acute - complications ; Liver Failure, Acute - physiopathology ; Liver Failure, Acute - surgery ; Liver Transplantation - physiology ; Monitoring, Intraoperative - methods ; Reoperation</subject><ispartof>Annals of transplantation, 2012-01, Vol.17 (1), p.117-121</ispartof><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,4026,27930,27931,27932</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22466917$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tsoulfas, Georgios</creatorcontrib><creatorcontrib>Elias, Nahel</creatorcontrib><creatorcontrib>Sandberg, Warren S</creatorcontrib><creatorcontrib>Ko, Dicken S C</creatorcontrib><creatorcontrib>Kawai, Tatsuo</creatorcontrib><creatorcontrib>Cosimi, A Benedict</creatorcontrib><creatorcontrib>Tsitsopoulos, Parmenion P</creatorcontrib><creatorcontrib>Agorastou, Polyxeni</creatorcontrib><creatorcontrib>Hertl, Martin</creatorcontrib><title>Liver transplantation results in complete neurologic recovery from malignant hypertension secondary to fulminant hepatic failure: a case report</title><title>Annals of transplantation</title><addtitle>Ann Transplant</addtitle><description>Uncontrolled intracranial hypertension can lead to cerebral herniation and death in patients with acute liver failure.
A 26-year-old female was admitted for acute liver failure following inadvertent acetaminophen overdose. The pH on admission was 6.9. Her neurologic status precipitously deteriorated and she was listed for liver transplantation. An intracranial pressure (ICP) monitoring catheter was inserted, which revealed a pressure >60 mmHg. After neurointensive care treatment, ICP was lowered and an emergency left lobe living donor liver transplant was performed. Intraoperative management of the ICP, which rose to 80 mmHg during the explant phase, was achieved by therapy with barbiturates and hypothermia. After surgery, hepatic function improved initially, but 7 days post transplantation the graft showed signs of acute failure. The pathology report of a liver biopsy suggested acute rejection and liver retransplantation using a deceased donor liver was then carried out. The postoperative course was uneventful and the patient recovered completely without any residual neurologic deficits.
This case states that favourable outcomes can result from sub-optimal starting points, and that the human brain has the ability to overcome extremely adverse conditions. Critical in this effort is the role of proper neuromonitoring which helps implement the appropriate treatment measures.</description><subject>Adult</subject><subject>Female</subject><subject>Hepatic Encephalopathy - complications</subject><subject>Hepatic Encephalopathy - surgery</subject><subject>Humans</subject><subject>Hypertension, Malignant - etiology</subject><subject>Hypertension, Malignant - physiopathology</subject><subject>Hypertension, Malignant - surgery</subject><subject>Intracranial Hypertension - complications</subject><subject>Intracranial Hypertension - surgery</subject><subject>Intracranial Pressure</subject><subject>Liver Failure, Acute - complications</subject><subject>Liver Failure, Acute - physiopathology</subject><subject>Liver Failure, Acute - surgery</subject><subject>Liver Transplantation - physiology</subject><subject>Monitoring, Intraoperative - methods</subject><subject>Reoperation</subject><issn>1425-9524</issn><issn>2329-0358</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kM1OAyEURonR2KZ25d6wN1OBgSm4a4x_SZNu6nrCUKgkDEyAMelT-Mqio67u4p7vuzcHgGuMVpg0TNxtdvsV56Sh9AzMSU1EhWrGz8EcU8IqwQidgWVKtkOUEIExY5dgRghtGoHXc_C5tR86whylT4OTPstsg4dRp9HlBK2HKvSD01lDr8cYXDhaVdYqlNgJmhh62Etnj75k4ftp0DFrn747UoH8QRYqB2hG19uJ0UO5oaCR1o1R30MJlUy6dA4h5itwYaRLevk7F-Dt6XH_8FJtd8-vD5ttpcrrueJ6TWTXGG0IpaghmjZcKc64RLyjHa8lFXTdKX7oGMFrLgU3SDDESYGEqOsFuJ16VQwpRW3aIdq-PNti1P6YbYvZdjJb6JuJHsau14d_9s9j_QU0GHeN</recordid><startdate>201201</startdate><enddate>201201</enddate><creator>Tsoulfas, Georgios</creator><creator>Elias, Nahel</creator><creator>Sandberg, Warren S</creator><creator>Ko, Dicken S C</creator><creator>Kawai, Tatsuo</creator><creator>Cosimi, A Benedict</creator><creator>Tsitsopoulos, Parmenion P</creator><creator>Agorastou, Polyxeni</creator><creator>Hertl, Martin</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>201201</creationdate><title>Liver transplantation results in complete neurologic recovery from malignant hypertension secondary to fulminant hepatic failure: a case report</title><author>Tsoulfas, Georgios ; Elias, Nahel ; Sandberg, Warren S ; Ko, Dicken S C ; Kawai, Tatsuo ; Cosimi, A Benedict ; Tsitsopoulos, Parmenion P ; Agorastou, Polyxeni ; Hertl, Martin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c246t-8e72ab6fef244062e468cc858a08b4b83a4947bc8db52178a98f095082c859933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Female</topic><topic>Hepatic Encephalopathy - complications</topic><topic>Hepatic Encephalopathy - surgery</topic><topic>Humans</topic><topic>Hypertension, Malignant - etiology</topic><topic>Hypertension, Malignant - physiopathology</topic><topic>Hypertension, Malignant - surgery</topic><topic>Intracranial Hypertension - complications</topic><topic>Intracranial Hypertension - surgery</topic><topic>Intracranial Pressure</topic><topic>Liver Failure, Acute - complications</topic><topic>Liver Failure, Acute - physiopathology</topic><topic>Liver Failure, Acute - surgery</topic><topic>Liver Transplantation - physiology</topic><topic>Monitoring, Intraoperative - methods</topic><topic>Reoperation</topic><toplevel>online_resources</toplevel><creatorcontrib>Tsoulfas, Georgios</creatorcontrib><creatorcontrib>Elias, Nahel</creatorcontrib><creatorcontrib>Sandberg, Warren S</creatorcontrib><creatorcontrib>Ko, Dicken S C</creatorcontrib><creatorcontrib>Kawai, Tatsuo</creatorcontrib><creatorcontrib>Cosimi, A Benedict</creatorcontrib><creatorcontrib>Tsitsopoulos, Parmenion P</creatorcontrib><creatorcontrib>Agorastou, Polyxeni</creatorcontrib><creatorcontrib>Hertl, Martin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Annals of transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tsoulfas, Georgios</au><au>Elias, Nahel</au><au>Sandberg, Warren S</au><au>Ko, Dicken S C</au><au>Kawai, Tatsuo</au><au>Cosimi, A Benedict</au><au>Tsitsopoulos, Parmenion P</au><au>Agorastou, Polyxeni</au><au>Hertl, Martin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Liver transplantation results in complete neurologic recovery from malignant hypertension secondary to fulminant hepatic failure: a case report</atitle><jtitle>Annals of transplantation</jtitle><addtitle>Ann Transplant</addtitle><date>2012-01</date><risdate>2012</risdate><volume>17</volume><issue>1</issue><spage>117</spage><epage>121</epage><pages>117-121</pages><issn>1425-9524</issn><eissn>2329-0358</eissn><abstract>Uncontrolled intracranial hypertension can lead to cerebral herniation and death in patients with acute liver failure.
A 26-year-old female was admitted for acute liver failure following inadvertent acetaminophen overdose. The pH on admission was 6.9. Her neurologic status precipitously deteriorated and she was listed for liver transplantation. An intracranial pressure (ICP) monitoring catheter was inserted, which revealed a pressure >60 mmHg. After neurointensive care treatment, ICP was lowered and an emergency left lobe living donor liver transplant was performed. Intraoperative management of the ICP, which rose to 80 mmHg during the explant phase, was achieved by therapy with barbiturates and hypothermia. After surgery, hepatic function improved initially, but 7 days post transplantation the graft showed signs of acute failure. The pathology report of a liver biopsy suggested acute rejection and liver retransplantation using a deceased donor liver was then carried out. The postoperative course was uneventful and the patient recovered completely without any residual neurologic deficits.
This case states that favourable outcomes can result from sub-optimal starting points, and that the human brain has the ability to overcome extremely adverse conditions. Critical in this effort is the role of proper neuromonitoring which helps implement the appropriate treatment measures.</abstract><cop>United States</cop><pmid>22466917</pmid><doi>10.12659/AOT.882644</doi><tpages>5</tpages></addata></record> |
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| ispartof | Annals of transplantation, 2012-01, Vol.17 (1), p.117-121 |
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| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Female Hepatic Encephalopathy - complications Hepatic Encephalopathy - surgery Humans Hypertension, Malignant - etiology Hypertension, Malignant - physiopathology Hypertension, Malignant - surgery Intracranial Hypertension - complications Intracranial Hypertension - surgery Intracranial Pressure Liver Failure, Acute - complications Liver Failure, Acute - physiopathology Liver Failure, Acute - surgery Liver Transplantation - physiology Monitoring, Intraoperative - methods Reoperation |
| title | Liver transplantation results in complete neurologic recovery from malignant hypertension secondary to fulminant hepatic failure: a case report |
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