Liver transplantation for sever hepatic trauma

Abstract text (incl. references and figure legends)

Case history: A 64-year-old male was injured at workplace when heavy machinery compressed the right side of his body. Injury led to hemodynamic instability. Clinical findings: Patient was brought to regional hospital and was immediately operated due to hemodynamic instability, damage-control surgery was unsuccessfully attempted. Patient was transferred to the tertiary centre where embolisation and definitive hemostasis was achieved. Investigation/Results: After stabilization other injuries were addressed. ISS was calculated at 45 (AIS 5 liver trauma, AIS 4 flail chest and AIS 2 extremity fracture). Diagnosis: Patient developed acute liver failure, was transferred to a transplant centre and placed on high urgency Eurotransplant list. Therapy and Progression: Liver transplantation was successfully performed 14 days after initial injury. During the surgery extensive liver necrosis and an unexpected ischemic segment of the transverse colon was found. Second-look procedure was performed due to the wall changes of the segment of the transversal colon, colon gangrene was found and right hemicolectomy with primary anastomosis was performed. On the fourth post-transplant day patient deteriorated, was re-operated and completion colectomy with terminal ileostomy formation was performed due to the found perforations of the left colon. Patient condition continuously worsened leading to multiorgan failure and death ten days after transplantation. Comments: Liver transplantation can be offered to selected patients following sever liver trauma as a possible life-saving procedure after all other treatment modalities have been exhausted. There are no widely established guidelines for the selection of the patients after severe liver trauma for liver transplantation. When facing a critically injured patient with severe hepatic trauma, an early referral to a specialized centre, where liver transplantation could be offered, should be a priority.

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

No