A 33-year-old woman with no previous morbidity from Puerto Varas.
Elective cystectomy and laparoscopic surgery were performed on July 18, 2003 under halothane anesthesia.
He was discharged without complications.
On the fifth postoperative day, the patient presented general malaise, nausea, vomiting, jaundice and progressive consciousness alteration compatible with hepatic encephalopathy. The patient was hospitalized with the diagnosis of fulminant hepatitis.
The etiologic study viral, metabolic, autoimmune and other drugs was negative.
She was referred to the Critical Patient Unit of Hospital Clínico San Arriarán (HCSBA) on August 5, 2003 with a diagnosis of acute fulminant hepatitis due to halothane and underwent liver transplantation
Given the vital emergency, an incompatible ABO cadaveric donor liver transplantation (group A donor, group O recipient) was performed on August 8, 2003, at Clínica Las Condes.
The therapeutic protocol consisted of intra- and post-transplant plasmapheresis, resection and quadruple immunosuppression with methylprednisolone, cyclophosphamide, thymoglobulin and cyclosporine.
Histopathological examination of the explant concluded submassive necrosis.
The patient received 5 sessions of plasmapheresis, which significantly decreased the titer of isoglutinins anti A. However, its subsequent increase did not decrease in a significant injury to the graft.
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In the early postoperative period he developed hemoperitoneum that required surgery, followed by acute lung disease.
Imaging and liver function tests were normal.
The patient was discharged 54 days after the transplant, in good condition with immunosuppressive therapy based on cyclosporine, cyclophosphamide and prednisone.
In her hospital evolution she presented cytomegalovirus infection in two opportunities satisfactorily treated, a moderate acute rejection corticoid-sensitive and a bilioma that required drainage under computed tomography.
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The patient attended regular medical check-ups and was discharged five years after transplantation.
Currently, an active working life is being developed, with normal liver tests, use of low dose immunosuppression (conserved renal function 200 mg/day, azathioprine 100 mg/day) and function.
