Tuesday July 03, 2018 from 16:30 to 17:30
Liver Transplantation due to Fulminant Liver Failure by Heat Stroke
Luis Martinez Insfran1, Pedro P Cascales Campos1, Pablo P Ramirez Romero1, Felipe F Alconchel Gago1, Beatriz B Gomez Perez1, Rocio Gonzalez Sanchez1, Guillermo G Carbonell3, Laura L Barona2, Francisco Sanchez Bueno1, Ricardo Robles Campos1, Pascual Parrilla Paricio1.
1Servicio de Cirugia General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Spain; 2Servicio de Anatomía Patológica, Hospital Universitario Virgen de la Arrixaca, El Palmar, Spain; 3Servicio de Radiologia, Hospital Universitario Virgen de la Arrixaca, El Palmar, Spain
Introduction and Objective: The Fulminant Liver Failure secondary to a maintained hypoxia of the organ, due to Heat Stroke is a very rare entity with a ominous prognosis. There is still controversy about the Liver Transplantation in this context, being an exceptional indication. We provide our experience regarding a recent case.
Clinical Case: A 32 years old man with no comorbidities, who while he was working in a summer afternoon in Murcia as a delivery boy, suffered a cognitive deterioration, coma, fever of 42ºC and seizures. Faced with this clinical syndrome of heat stroke, precise hospital admission in ICU, receiving a conservative support with mechanical ventilation, hemodialysis and inotropic support on the first days, adding signs of Fulminant Liver Failure as coagulopathy (prothrombin activity <10%), elevation of transaminases (> 10,000) and hyperammonemia. Urgent liver transplantation is indicated. In the postoperative period, the patient progressed favorably with restoration of liver function and resolution of multi-organ failure, being high one month post-transplant.
Conclusions: With only 6 cases published in the existing literature, with diverse outcomes, the indication of Liver Transplantation is still controversial. In short, Fulminat Liver Failure due to Heat Stroke is a potentially fatal situation in which urgent liver transplantation should be considered as a therapeutic option in case of failure of conservative management.