A 61-year-old male mining patient with a history of gout was treated with allopurinol and diclofenac.
On 29 May 2005 he consulted due to an engagement table in the general state and institution.
In the biochemical study highlighted bilirubin: 20 mg/dL, oxalacytic glutamic transaminase (GOT): 2.350 U/L, alkaline transaminase glutamic pyruvic (GOT): 1.845 U/L
Studies for viral and autoimmune hepatitis, as well as for metabolic diseases affecting the liver (deficit of 1-antitrypsin, Wilson's disease and hemochromatosis), were negative.
Abdominal computed tomography (CT) showed a small liver.
Upper endoscopy showed incipient esophageal varices.
There was no history of alcohol abuse and pesticide exposure on a regular basis.
The patient had a family history of liver disease.
On July 6, Santiago was diagnosed with subacute hepatitis of unknown etiology.
Clinically, he was jaundiced, with grade II hepatic encephalopathy and mild ascites.
In the new laboratory studies performed, the following stood out: immunoglobulins: IgG: 1.838 mg/dL (700-1,600), IgA: 1.193 mg/dL (70-400), IgM: 118 mg/dL total albumin UGT: 202 g
On July 8, the patient was activated for emergency transplant on the national list due to his progressive deterioration, maintaining grade II III encephalopathy. However, after 3 weeks of waiting for a cadaveric organ, the patient was submitted to a living donor protocol August 3,
As immunosuppression, tritherapy with prednisone, cyclosporine and mycophenolate was used.
The patient developed progressive jaundice and severe ascites that required paracentesis evacuator, albumin and octreosis.
At the third week post-transplant bilirubin levels remained elevated at 27 mg/dL, with a 62% decrease in prothrombin time, with no evidence of significant changes in both the level of transplant enzymes as focal liver metastases.
Two episodes of cholangitis occurred, one of which was positive for E coli.
He was successfully treated with cefepime and vancomycin.
A retrograde cholangiopancreatography was performed and an endoprosthesis was installed due to biliary stenosis in the area of anastomosis.
Despite this, serum bilirubin levels remained elevated.
Imaging tests and a new cholangiography ruled out new alterations of the biliary tract, although an abdominal CT angiography of 5/9/05 showed a large hypoperfused area in the early arterial phase.
The hepatic artery was patent, without alteration of the hepatic veins or signs of thrombosis.
A liver biopsy showed extensive congestion, hemorrhage and central lobular necrosis on September 8, 2005.
Given the persistence of the picture of tension ascites and the progressive deterioration of liver function, on September 13, a mesocaval shunt was performed with a 7M Dacron prosthesis in a termino-lateral form.
The patient achieved a significant improvement in all parameters.
Bilirubinemia decreased progressively and a recovery of prothrombin time was observed, with disappearance of ascites.
During the following months, the patient was monitored regularly, and liver function parameters were normal.
The CT performed on October 19, 2005 showed that the mesocaval shunt was not permeable.
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The donor was discharged at 7 days and had no complications related to surgery after 2 years of follow-up.
