S3200 Unexpected Outcome of Ischemia-Reperfusion Injury Following Liver Transplantation: A Case Series

Abstract

Introduction: Severe ischemia-reperfusion injury is a potential deadly complication after liver transplantation that is characterized by a significant elevation of liver enzymes. It is usually complicated by severe organ dysfunction, rejection, and re-transplantation. In this case series, we report three cases of severe ischemia-reperfusion injury following liver transplantation with unexpected clinical course. Case Description/Methods: Three cases of patients with autoimmune hepatitis, alcoholic cirrhosis, and idiopathic liver cirrhosis were selected. All of them underwent liver transplantation. Few hours after the surgery, their liver enzymes started to rise to the thousands raising concern for ischemia-reperfusion injury (Image 1). Patients remained clinically stable with reduced but preserved urine output and state of consciousness. Doppler-ultrasound of the graft revealed patent hepatic artery, hepatic vein, and portal vein. Therefore, the patients received supportive care. After few days of observation, liver enzymes started to decrease unexpectedly reaching a normal level after a week. The patients gradually improved and their liver function remained stable upon follow-up after discharge from the hospital. Discussion: Severe ischemia-reperfusion injury is a potential deadly complication of liver transplantation. Liver function test abnormalities following liver transplantation are a hallmark of the clinical presentation. Upon diagnosis, the outcome is usually poor without re-transplantation. In this study, we presented three cases of patients with increased LFTs following liver transplantation, who improved with supportive measures alone. Although LFTs are commonly accepted as indicators of liver injury post-transplant, these cases highlight the importance of taking into account other parameters such as the clinical picture and radiological findings before determining the outcome of the ischemia-reperfusion injury following liver transplant; therefore, avoiding unnecessary and invasive measures.Figure 1.: Post-transplant AST and ALT levels in patient with autoimmune hepatitis (a), alcoholic cirrhosis (b), and liver cirrhosis of unknown origin (c).