Living Donor Liver Transplantation for Acute Liver Failure With Fixed Pupils: Are We Fixed?

Abstract

Living donor liver transplantation (LDLT) is fraught with the social and ethical dilemma of excising a part of the liver from a healthy first-degree relative. When LDLT is to be done for an acute liver failure (ALF), identification of a suitable donor is a race against time. Herein, we describe a unique challenge faced by the transplant team of whether to proceed with donor hepatectomy from a son, when the recipient (HBV-related ALF) developed non-reactive fully dilated pupils on the table, prior to beginning the surgery. The patient ultimately underwent a LDLT despite fixed dilated pupils by virtue of further workup, which suggested that cerebral blood flow was maintained despite clinical evidence of brainstem herniation.

Role of neuro-monitoring in acute liver failure patient with fixed dilated pupil for emergency liver transplant - a novel case report

“…2,3 Living Donor Liver Transplantation for Acute Liver Failure With Fixed Pupils: Are We Fixed? A case report by Shwetha A Singh et al 4 performed liver transplantation in patient with fixed dilated pupil based on CT angiogram findings which is time taking procedure and should not be performed in the state of haemodymaic fluctuations with high nor adrenaline and vasopressin infusion.…”