Abstract
BackgroundHepatic artery thrombosis is a devastating complication after orthotopic liver transplantation often requiring revascularization or re-transplantation. It is associated with considerably increased morbidity and mortality. Acute cognitive dysfunction such as delirium or acute psychosis may occur after major surgery and may be associated with the advent of surgical complications.Case presentationHere we describe a case of hepatic artery thrombosis after living-donor liver transplantation which was not preceded by signs of liver failure but rather by an episode of acute psychosis. After re-transplantation the patient recovered without sequelae.ConclusionThis case highlights the need to remain cautious when psychiatric disorders occur in patients after liver transplantation. The diagnostic procedures should not be restricted to medical or neurological causes of psychosis alone but should also focus vascular complications related to orthotopic liver transplantation.
Highlights
Hepatic artery thrombosis is a devastating complication after orthotopic liver transplantation often requiring revascularization or re-transplantation
The diagnostic procedures should not be restricted to medical or neurological causes of psychosis alone but should focus vascular complications related to orthotopic liver transplantation
Fever, systematic inflammatory response syndrome, or hepatic failure may ensue in early Hepatic artery thrombosis (HAT), whereas presentation of late HAT may vary from biliary complications such as recurrent biliary sepsis and stenotic lesions of the biliary tract, to an asymptomatic clinical picture with a mild elevation of serum transaminases and bilirubin levels [2,6]
Summary
We propose that in the described patient HAT is the most likely cause of an acute liver failure laboratory findings indicated only mild graft dysfunction. Acute liver failure was accompanied by hepatic encephalopathy apparent as acute delusional psychosis. This case highlights the need to remain suspicious when psychiatric disorders occur in patients after liver transplantation.
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