Abstract
Objective: To establish the feasibility of TALT in the treatment of fulminant VHA in children Background: emergency orthotopic liver transplantation (OLT), although dramatically improving the prognosis of fulminant liver failure in adults and in children, is an procedure which implicates the removal of the patient's native liver while the recovery of hepatic function patients who survive under supportive tretment is possible.
Design: case report.
Patients: A 4 year old male presented with fulminatn VHA, characterized with a grade 4 encephalopathy, a 74 5 sec(control 12 sec) time and a 611 μmol l serum total bilirubin level. Serum IgM antibodies level for hepatitis A virus was 1/10640 (ELISA)
Methods: FALT consisted in the orthotopic transplantation of the segments 2 and 3 of a reduced liver provening from a calaveric donor, after segments 2 to 1 of the recepients had had been resected immunosuppressive therapy included ciclosporine and azathioprine. Evolution was followed by usual biological liver function tests, and by perindical comparison of biliary exerction of circlosporine, biliary isotopic seans and biopsy specimens between the native and the transplanted liver.
Results: The patients recovered a nearly normal liver function and consciousness on day 3 after TALT. Complications included a peritomtis which occuted on the third week after TALT and necesitated a re-operation, and a concurrent acute liver rejection which was treated with OKT3 antibodies. Afterwards, liver biological tests evoluted towards normalization, while ciclosporine levels in the bile provening from the recipients own liver increased, and serial biliary isotopic scans as well as liver biopsis showed a progressive recovery of the patient's native liver function and morphology. Surgical removal of the graft was performed three months after TALT, and immunosuppressive therapy was discontinuated, allowing the complete recovery of the patient.
Conclusion: TALt may represent a suitable therapeutic procedure for fulminant liver failure due to vital hepatitis A, avoiding the removal of the patient's native liver and allowing consequently the discontinuation of immunosuppressive therapy.
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Simeom, U., Boadjema, K., Jaeck, D. et al. TEMPORARY AUXILIARY LIVER TRANSPLANTATION (TAEF) FOR FULMINANT VIRAL HEPAITERS A (VHA) IN A CHILD. Pediatr Res 35, 265 (1994). https://doi.org/10.1203/00006450-199402000-00067
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DOI: https://doi.org/10.1203/00006450-199402000-00067