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Successful living donor liver transplantation for acute liver failure after acetylsalicylic acid overdose

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Abstract

A 20-year-old woman was admitted to an emergency hospital after ingesting 66 g of acetylsalicylic acid in a suicide attempt. Although she was treated with gastric lavage, oral activated charcoal, and intravenous hydration with sodium bicarbonate, her hepatic and renal function gradually deteriorated and serum amylase levels increased. Steroid pulse therapy, plasma exchange, and continuous hemodiafiltration did not yield any improvement in her hepatic or renal function, and she was transferred to our hospital for living donor liver transplantation. Nine days after drug ingestion, she developed hepatic encephalopathy: thus, we diagnosed the patient with acute liver failure with hepatic coma accompanied by acute pancreatitis due to the overdose of acetylsalicylic acid. Living donor liver transplantation was immediately performed using a left lobe graft from the patient’s mother. Following transplantation, the patient’s renal and hepatic function and consciousness improved, and she was discharged. In this report, we describe a rare case of acetylsalicylic acid-induced acute liver failure with acute hepatic coma and concomitant acute pancreatitis and acute renal failure, which were treated successfully with emergency living donor liver transplantation.

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Abbreviations

ALF:

Acute liver failure

LDLT:

Living donor liver transplantation

ASA:

Acetylsalicylic acid

PT-INR:

Prothrombin time-international normalized ratio

MELD:

Model for end-stage liver disease

PE:

Plasma exchange

CHDF:

Continuous hemodiafiltration

WBC:

White blood cell count

HB:

Hepatitis B

T-bil:

Total bilirubin

Cr:

Creatinine

CT:

Computed tomography

SLV:

Standard liver volume

NSAID:

Nonsteroidal anti-inflammatory drug

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Disclosures

Conflict of Interest:

Tomoki Shirota and co-authors have no conflict of interest

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed Consent:

Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan

    Tomoki Shirota, Toshihiko Ikegami, Satoshi Sugiyama, Kouji Kubota, Akira Shimizu, Yasunari Ohno, Atsuyoshi Mita, Koichi Urata, Yuichi Nakazawa, Akira Kobayashi & Shinichi Miyagawa

  2. Department of Pathology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan

    Mai Iwaya

Authors
  1. Tomoki Shirota
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  2. Toshihiko Ikegami
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  3. Satoshi Sugiyama
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  4. Kouji Kubota
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  5. Akira Shimizu
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  6. Yasunari Ohno
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  7. Atsuyoshi Mita
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  8. Koichi Urata
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  9. Yuichi Nakazawa
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  10. Akira Kobayashi
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  11. Mai Iwaya
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  12. Shinichi Miyagawa
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Correspondence to Tomoki Shirota.

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Shirota, T., Ikegami, T., Sugiyama, S. et al. Successful living donor liver transplantation for acute liver failure after acetylsalicylic acid overdose. Clin J Gastroenterol 8, 97–102 (2015). https://doi.org/10.1007/s12328-015-0553-3

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  • DOI: https://doi.org/10.1007/s12328-015-0553-3

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