Introduction: Exertional heatstroke is an extremely rare cause of fulminant hepatic failure,
and when complicated by multiorgan failure, is fatal without liver transplantation. The ability
to support patients with heat stroke complicated by massive hepatic necrosis with
mechanical replacement therapies while awaiting recovery or transplantation has not been
reported. We utilized a multidisciplinary approach of critical care and liver transplant
specialists to rapidly identify and treat cases of heat stroke-induced liver failure. Methods:
A retrospective review of three consecutive cases of male patients with fulminant hepatic
failure from exertional heatstroke was performed after IRB approval. Results: All patients
developed multiorgan failure, and required intubation, renal replacement therapy, and
vasopressor support. All patients were listed urgently for liver transplantation, and were
supported with the Molecular Adsorbent Recirculating System while awaiting transplantation.
All patients underwent liver transplantation alone, and the liver explant showed massive
hepatic necrosis in all cases. All patients required multiple operations including fasciotomy,
serial washout, and wound closure. Renal replacement therapy was weaned within 30 days.
All patients remain alive and well, with normal renal function, normal liver allograft function,
and no long term sequelae of their multiorgan failure at 1, 2, and 4 years post-transplantConclusion: Extreme heatstroke leading to whole-body organ dysfunction and fulminant
liver failure is a complex entity that can be successfully treated with liver transplantation as a
component of a multidisciplinary, multiorgan system approach.