Conscious recovery response in post-hepatic transplant as a function of time-related acute hepatic encephalopathy

H Coma due to acute hepatic failure produces a high mortality rate with rapid progression of cerebral edema and brain herniation. Early transplantation increases survival of patients with acute hepatic encephalopathy. In previous studies, scant attention has focused on the conscious recovery time after living donor liver transplantation (ldlt) and whether the conscious recovery time was directly proportional to the length of coma before transplantation.

We have reported herein three adult patients with decompensated chronic end-stage liver disease who underwent right lobe LDLT. Their general conditions had markedly deteriorated; two patients displayed massive ascites. All three subjects displayed grade IV encephalopathy with endotracheal intubation and intensive care management. Their biochemical data revealed hyperammonemia, marked cholestasis, and coagulopathy.

After LDLT the patients recovered from coma at a mean time similar to that in coma. Preoperatively the patients exhibited acute deep coma with respiratory failure on preoperative days 5, 3, and 1 with consciousness regained on postoperative day 5, 3 and 1, respectively.

We suggest that patients with acute deep coma (grade IV), who were formerly regarded as irreversible, benefit with LDLT, preventing worsening of complications, and that shows a time-dependent recovery the pretransplant comatose status.