Liver Transplantation for Acute Liver Failure After Intentional Iron Overdose: A Case Report and Literature Review

Acute iron poisoning can result in severe complications such as acute liver failure, renal dysfunction, and cerebral edema. Iron overdose, often accidental in infants or intentional in adolescents for suicidal attempts, can be fatal due to its cytotoxic effects.

We present the case of a 13-year-old female who developed acute liver failure due to iron overdose (45 mg/kg). She had been prescribed iron supplements for anemia but overdosed due to personal distress. Despite initial treatment with deferoxamine, her condition deteriorated. Imaging revealed extensive liver necrosis, and she developed fulminant hepatic failure with coma. Continuous renal replacement therapy for anuria and plasma exchange was initiated. Brain MRI demonstrated cerebral edema and central herniation when her level of consciousness decreased. Osmotherapy and fluid management helped stabilize her neurological status. After 18 days, the patient underwent deceased donor liver transplantation. After surgery, liver and renal function recovered completely, and she was discharged 40 days after surgery without neurological complications. From the review of the literature, early intervention after overdose could lead to a good prognosis. In addition, all reported cases of renal dysfunction from iron overdose resolved after liver transplantation.

Effective management of complications such as cerebral edema and renal failure is critical to bridging the patient to transplantation. Liver transplantation remains the only definitive treatment for iron-induced liver failure, and timely intervention can significantly improve survival and recovery.