Late-onset acute liver failure due to Wilson’s disease managed by plasmapheresis and hemodiafiltration successfully serving as a bridge for deceased donor liver transplantation: a case report and literature review

Akira Sukezaki, Po sung Chu, Masahiro Shinoda, Taizo Hibi, Nobuhito Taniki, Aya Yoshida, Miho Kawaida, Shutarou Hori, Rei Morikawa, Arata Kurokouchi, Shu Wakino, Kaori Kameyama, Hideaki Obara, Yuko Kitagawa, Hidetsugu Saito, Takanori Kanai, Nobuhiro Nakamoto

Research output: Contribution to journalArticle

Abstract

Late-onset acute liver failure due to Wilson’s disease (WD-ALF) is rare. A 44-year-old female patient presenting acute hepatic decompensation with extreme coagulopathy was transferred to our hospital for evaluation for liver transplantation (LT). Alveolar hemorrhage and Coombs-negative acute hemolysis occurred during workup. Mechanical ventilation, plasmapheresis, and hemodiafiltration with zinc and chelation were started immediately before placing the patient on the waitlist for deceased donor LT (DDLT), with a tentative diagnosis of WD-ALF using the Leipzig score and quick diagnostic criteria suggested by the Acute Liver Failure Study Group Registry. The peak MELD score was 40, and the revised version of King’s score for WD was 13. Serum free copper levels and the patient’s overall general condition were stabilized with artificial support systems, although triphasic wave on electroencephalogram and liver atrophy were noted. She successfully underwent emergent DDLT approximately 2 weeks after suffering from acute hemolysis and survived. The genetic tests confirmed mutations at 2 loci in the ATP7B gene and, therefore, the diagnosis of WD. This is the first and oldest patient reported in Japan to present late-onset WD-ALF that was successfully treated with emergent DDLT.

Original languageEnglish
JournalClinical journal of gastroenterology
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Acute liver failure
  • Acute-on-chronic liver failure
  • Adult
  • Deceased donor liver transportation
  • Wilson’s disease

ASJC Scopus subject areas

  • Gastroenterology

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