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| Emergency ABO-incompatible living donor liver transplant for patients with ultrahigh MELD scores |
| Kevin KW Chu a , Kenneth SH Chok a , ∗, James YY Fung b , Albert CY Chan a , Wing Chiu Dai a , Chung Mau Lo a |
a Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
b Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
∗ Corresponding author.
E-mail address: kennethchok@gmail.com (K.S. Chok). |
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Abstract A 49-year-old Chinese man with treatment-naïve chronic hepatitis B presented with a one-week history of jaundice when admitted to our hospital. On admission, his bilirubin was 704 μmol/L, alanine aminotransferase 180 U/L, international normalized ratio 2.4, creatinine 140 μmol/L, and Model for End-stage Liver Disease (MELD) score 35. His serum HBV DNA was 64.7 IU/mL, and he was commenced on entecavir. Nonetheless, he developed acute-onchronic liver failure on day 28 with grade 2 hepatic encephalopathy and a MELD score of 40 (bilirubin 709 μmol/L, international normalized ratio 3.3, creatinine 181 μmol/L). During his admission, he developed bacteremia and spontaneous bacterial peritonitis (SBP). His blood culture was positive of enterococcus faecium and coagulase-negative staphylococcus and his peritoneal fluid culture was positive of coagulase-negative staphylococcus . This was further complicated by the development of type 1 hepatorenal syndrome. His initial condition was so poor that intensive care with inotrope was needed. At the time of preconditioning, the sepsis due to SBP was barely controlled after optimization.
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2019, Vol. 18 
