Auxiliary liver transplant in fulminant failure

Fulminant hepatic failure (FHF) is defined as a syndrome of acute liver failure with the development of hepatic encephalopathy and severe hypoprothrombinemia occurring within 2 months of the onset of symptoms or jaundice in a person without preexisting liver disease. Total orthotopic liver transplantation (OLTX) is a lifesaving therapeutic option for patients with FHF, but currently requires lifelong immunosuppression to maintain the graft. Auxiliary partial orthotopic liver transplantation (A-OLTX) is a procedure whereby only a portion of the native liver is removed, and the remainder of the native liver is left in situ. A-OLTX provides temporary support until the native liver recovers and immunosuppression can be withdrawn. We describe the successful application of emergency A-OLTX in a young girl who accidentally ingested Amanita phalloides mushrooms and developed FHF.