A new possible therapeutical approach to the toxic acute liver failure: portal vein arterialization

Abstract

Background: Acute Hepatic Failure (AHF) is a deadly condition in which liver regeneration (LR) is suppressed. Imbalance between growth factors and inflammatory cytokines play a pathogenetic role. Portal vein arterialization (PVA) is a technique employed in the field of transplantation (LT) or hepatic surgery to replace arterial flow and to enhance LR. Experimental and clinical reports support the effectiveness of PVA to reverse apoptosis. Methods: We Report a case of a 24 years man with AHF from drug assumption, leading to deep coagulopathy (INR: 6,23) and coma (Glasgow Coma Score: 3). Because of the unvailability of LT, he underwent PVA anastomosing the inferior mesenteric vein and artery end to side. A liver biopsy was taken. Results: Liver function tests (LFT) improved after PVA. The AST level dropped from 2840 U/l to 1 U/l in the 1st postop day. The INR value from 6.2 arrived to 1.5 after 5 days. The bilirubin from 278 mml/l to 192 mml/l. The ammonia value from 367 to 165 mml/l. Ultrasound showed mixed arterovenous flow in the portal trunk. Unfortunately the patient developed bilateral pneumonia and died from sepsis 6 days after PVA but with progressively improving LFT. Conclusion: PVA is a simple technique that could help to restore liver function in toxic AHF. Changes in the quality of flow can enhance the mitogenic stimulus and reverse the apoptosis. Induced portal hypertension is the major concern after PVA, but the fistula can be easily interrupted by interventional radiology. Further experiences are required.