unfortunately i think that he may require retransplantation. Typically rejection doesnt occur this early after transplantation but he may have antibody mediated rejection or another complication related to the dsurgery itself
Surgical Gastroenterology & Liver transplantation
Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi – 110060
Liver Transplant Unit
Dr. Naimish N. Mehta Dr. Shailendra Dr. Vivek Dr. S. Nundy
MBBS, MS, FACRSI MBBS, MS, DNB(GI Surg), MNAMS MBBS, MS, MCh(AIIMS) MA,MChir,FRCS,FRCP
Consultant Consultant Consultant Consultant
Name: Jai Prakash Jha Age / Sex: 60 Y/Male Hospital No: 1427731
Admission Date: 27/03/2014 Date of Transplant: 21/02/2014
Address: A-20, Police Colony, Anisabad, Patna-2
Diagnosis: Cryptogenic Chronic Liver Disease with Ascites with portal hypertension with Umbilical hernia with scrotal swelling.
60 yrs old male is a known case of Cryptogenic Chronic Liver Disease with Ascites with portal hypertension for last 6 years. Underwent living donor liver transplant (left lobe orthotopic liver transplant) on 04/04/2014. GRWR was 0.8. Post operatively he was shifted to liver ICU and he was extubated on 7/4/14. His inotropic support gradually tapered. On ABG lactate became normal. Post operatively his enzymes were normal till postoperative day one. On postoperative day two his enzymes were elevated & bilirubin levels were also increased. Urgent USG Doppler was done which showed normal arterial and portal vein flow. He underwent CT angio which showed normal artery, portal vein and hepatic veins. On postoperative day three his enzymes further went up. His procalcitonin was 6.6 so antibiotics were upgraded. His enzymes continued to rise (SGOT 2179 and SGPT 2403 and bilirubin was 20). He was treated with pulse therapy with methyl predinsolone and his enzymes showed downtrend and gradually it became normal in next 5 days. His bilirubin continued to rise and reached upto 29.86. His INR continue to be high (between 2.6 to 4.5). His drain output was high initially but gradually started coming down upto 2300 ml. Presently he is in ICU and on minimal inotropic support (noradrenalin 2ml/hour). He is on oral and RT feed. He is requiring intermittent BIPAP support. He is maintaining his urine output and creatinine is normal. All cultures are negative till date. Transjugular liver biopsy done on 16/04/2014 suggestive of massive hepatic necrosis with marked ductal proliferation.