Postoperative liver failure

Patient selection criteria for hepatectomy following PVE are still under investigation. For Wakabayashi et al. postoperative liver failure appears to be more severe in patients having high portal pressure and hypertrophy of the FRL lower than 20% [55]. In another study, the same team founded that portal pressure and serum level of hyaluronate measured before and after PVE were the most useful parameters in prediction of the outcome of the following... 

The best chance of cure is offered by complete surgical resection with negative margins and restoration of biliary-enteric continuity. Resectability criteria are based on tumour extension, vascular involvement, distant metastases, the presence of coexistent liver disease or dysfunction, portal hypertension and the general condition of the patient. CCA is resectable if vascular and biliary ductal involvement is limited to one lobe of the liver, if there is no extrahepatic disease, and the patient is fit for surgery. In patients in whom the proportion of the liver to be resected is substantial, it may be useful to carry out preliminary embolisation of the appropriate branch of the portal vein, in order to induce compensatory hypertrophy of the residual lobe, which minimises the risk of postoperative liver failure. In case of doubt, surgical exploration can be performed, in order to determine the chance of resectability. 

Sato, T., Asanuma, Y., Hashimoto, M., Heianna, X, Kusano, T., Kuro-kawa, T., Yasui, O., Koyama, K. Efficacy of hepatic arterial infusion of prostaglandin El in the treatment of postoperative acute liver failure. - Report of a case. Hepato-Gastroenterol. 2000 47 846-850... 

As the management of liver transplantation has improved, absolute and relative contraindications have been established. Relative contraindications may question the success of LT in some cases. Obesity leads to an increased rate of postoperative complications, but it does not influence the survival rate. (396, 403) (s. tab. 40.16) Contraindications should also be considered in urgent LT due to acute liver failure - possibly accompanied by necrotizing pancreatitis, septic shock and problems with assisted respiration. Visceral inversion is not deemed to be a contraindication a successful LT was indeed carried out under such conditions by G.B. Rlintmalm et al. in 1993. 

Clinically important acute renal failure associated with CsA use can occur in a significant number (ranging from 10 to more than 50%) of patients in the postoperative period of heart, liver and bone marrow transplantation [226, 242-244, 252-254]. Acute renal failure in these patients is generally multifactorial and very seldom related exclusively to CsA. More than 40% of... 

A 21-year-old man took levetiracetam for partial seizures for 1 month, and had a generalized seizure preceded by a 6-day history of pale stools, dark urine, and jaundice. The serum bihmbin was 591 pmol/1, alanine aminotransferase 1610 U/1, alkaline phosphatase 246 U/1, and the international normalized ratio (INR) 3.6. A liver biopsy showed massive confluent hepatocyte necrosis with no evidence of pre-existing liver disease. Levetiracetam was withdrawn but the Uver failure continued to deteriorate and he subsequently required hver transplantation. Postoperatively levetiracetam... 

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