Long-term survival after 66 hours of anhepatic time with no neurological deficit

Intractable intraoperative hemorrhage is a rare complication of liver transplantation. Rescue hepatectomy with portocaval shunting can be used as a bridging procedure until a new organ donor becomes available. During the anhepatic period, however, there is a substantial risk of developing end-organ damage, the brain being particularly susceptible to insult.

A 66-year-old male underwent liver transplantation due to non-alcoholic steatotic hepatitis and hepatocellular carcinoma. The transplantation was complicated by perioperative intractable bleeding. Despite attempts to control the bleeding, the patient became hemodynamically unstable and a rescue hepatectomy with portocaval shunting was performed. The patient remained anhepatic for 66 hours in an intensive care unit until a second donor organ was found. He made a good recovery and had no neurological deficit.

Rescue hepatectomy with portocaval shunting is a viable short-term solution until a suitable donor organ is found. During this period, inotrope infusion and continuous veno-venous hemofiltration within an intensive care unit setting can be used as supportive measures. Nevertheless, a prolonged anhepatic time increases the risk of multiple organ failure and should be kept to a minimum due to metabolic disturbance and the build-up of toxic metabolites.