Comprehensive treatment of acute-on-chronic liver failure in a patient with hepatitis B: a case report

Abstract

The clinical data of a patient with acute-on-chronic liver failure were analyzed retrospectively. The patient has suffered from hepatitis B for 30 years. His liver function deteriorated, yielding Child-Pugh grade C and reaching a model for end-stage liver disease score of 33 points within a short period; this condition was complicated with highly active variceal bleeding and coagulation system failure (PT > 100 s). The patient also presented hepatocellular carcinoma. Comprehensive treatments included effective inhibition of hepatitis B virus replication and intensive care support. Piggyback orthotopic liver transplantation was performed as the final treatment. The patient recovered uneventfully and was discharged after surgery.

Keywords

acute-on-chronic liver failure / submassive necrosis / viral hepatitis B / esophageal variceal bleeding / liver transplantation

References

[1] JalanR, GinesP, OlsonJC, MookerjeeRP, MoreauR, Garcia-TsaoG, ArroyoV, KamathPS. Acute-on-chronic liver failure. J Hepatol2012; 57(6): 1336–1348

[2] OlsonJC, KamathPS. Acute-on-chronic liver failure: concept, natural history, and prognosis. Curr Opin Crit Care2011; 17(2): 165–169

[3] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association. Severe Liver Disease and Artificial Liver Study Group, Chinese Society of Hepatology. Guidelines on the management of liver failure. J Clin Hepatol (Shi Yong Gan Zang Bing Za Zhi)2006; 9: 321–324 (in Chinese)

[4] GargH, SarinSK, KumarM, GargV, SharmaBC, KumarA. Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure. Hepatology2011; 53(3): 774–780

[5] WangJ. Clinical utility of entecavir for chronic hepatitis B in Chinese patients. Drug Des Devel Ther2013; 8: 13–24

[6] MatthewsSJ. Entecavir for the treatment of chronic hepatitis B virus infection. Clin Ther2006; 28(2): 184–203

[7] GuoLY, WangGJ. Clinical observation of somatostatin combined with terlipressin for acute esophageal variceal bleeding in cirrhosis patients. China Pharm (Zhongguo Yao Fang)2012; 32 (in Chinese)

[8] RengstorffDS, OsorioRW, BonaciniM. Recovery from severe hepatitis caused by mushroom poisoning without liver transplantation. Clin Gastroenterol Hepatol2003; 1(5): 392–396

RIGHTS & PERMISSIONS

Higher Education Press and Springer-Verlag Berlin Heidelberg