Liver transplantation due to Fulminant Liver Failure secondary to hepatic submassive necrosis in a patient treated with Orlistat

Abstract

Introduction and objective: Orlistat is an intestinal lipase inhibitor drug, approved by the Food and Drug Administration in 1998, which has been shown to be superior to placebo in weight loss and is currently recommended in obese patients along with a hypocaloric diet. Although the most frequent secondary effect is the steatorrhea, Fulminant Liver Failure has been associated with this drug. We present a case of urgent liver transplantation due to acute liver failure associated with this drug treatment. Clinical case: A 42 year old man with hypertension, obesity and the diagnosis of liver steatosis, in treatment with hypocaloric diet and Orlistat 240 mg/day, suffered a Fulminant Liver Failure with coagulopathy, oliguria and grade II-III encephalopathy. Despite conservative treatment, he clinically worsens substantially, being submitted for an urgent liver transplant. After a favorable postoperative, on the 26th day post-transplant the patient is discharged in good conditions. Currently the patient has a good standard of living 8 years after the transplant. Conclusion: Obesity has become a major health problem and Orlistat is currently an available drug of proven effectiveness. Although the direct cause of this drug with the development of a Fulminant Liver Failure is not demonstrated, it is assumed that they would be involved in idiosyncrasy mechanisms. Therefore, we believe that we should be aware of this possibility and closely monitor patients who have steatosis with signs of hepatic dysfunction.