Exertional Heat-Stroke Causing Acute Liver Failure: An Atypical Indication for Liver Transplantation

Abstract

Listen

Translate article

Introduction: Heat stroke is a situation conditioned by the inability of the body to dissipate excess heat produced by physical exercise. The association of liver damage is not rare, but some patients may progress to fulminant hepatic failure (FHF) requiring liver transplantation. So far, only 5 exertional heat stroke cases requiring liver transplantation have been reported in the literature. Patients and methods: We performed a retrospective review of all patients undergone liver transplantation in our department and we found 2 cases in which the etiology was a heat stroke. Results: The first case is a man of 23 years with no interest past history, who performing military maneuvers, suffers heat stroke, evolving in a few hours with significant clinical deterioration, abnormal liver profile (AST 8945 IU/l, ALT 9322 IU/l), encephalopathy, severe coagulopathy, thrombocytopenia, and acute renal failure. Given the clinical situation and the lack of response to intensive care treatment, liver transplantation from brain death donor was performed 72 hours after the beggining. The postoperative course was torpid, with many complications and the patient was discharged 2 months after transplantation. The second case is another man of 37 years who after heat stroke, secondary to physical exertion, develops a clinical situation compatible with FHF, also undergoing emergency liver transplantation. As in the first case the postoperative course was complicated and the patient was not discharged until the 77th post-transplant day. Currently, after a mean follow-up over 5 years, both patients remain asymptomatic showing normal liver graft function. Conclusions: Heat stroke secondary to stress can trigger liver damage, that in some cases, can progress rapidly to FHF and multiple organ failure with high mortality risk. In these cases, the implementation of an early emergent liver transplantation improves the prognosis of these patients.