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Abstract
We report a case of fatal pulmonary hemorrhage developed after reperfusion of grafted liver during a living-related liver transplantation. A 53 year-old man who had hepatic encephalopathy grade 4 with fulminant hepatic failure was scheduled for a living-related liver transplantation. Preoperative evaluation showed fever, hypoxia, hypotension, pneumonia, and pulmonary edema. Cardiopulmonary stability was maintained with oxygen therapy and inotropic agents. During the anhepatic period, the patient's vital signs remained stable with inotropic agents except one episode of sudden hypotension presumably due to right heart strain. However, hypoxia, acidosis, and electrolyte imbalance were becoming worsen in spite of variable treatments for correction. Immediately after reperfusion, a sudden increase of central venous pressure and pulmonary artery pressure was noticed. Severe bradyarrhythmia, hypotension, hemoptysis, hypoxia, and acidosis were followed by cardiac arrest. Cardiopulmonary resuscitation was not successful and the patient expired.
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