Perioperative journey of a living donor liver transplantation in a patient with Child-Pugh class C cirrhosis and massive hepatic hydrothorax

Abstract

Metabolic dysfunction-associated fatty liver disease (MAFLD) is now a leading cause of cirrhosis and an increasingly common indication for liver transplantation [1]. Decompensated disease is often accompanied by hepatic hydrothorax, for which liver transplantation is the definitive treatment [1]. Hepatopulmonary syndrome, which affects an estimated 10-30% of transplant candidates and generally resolves after transplantation [2]. Both conditions complicate anaesthetic management of living donor liver transplantation (LDLT). We present a middle aged man with MAFLD-related Child-Pugh class C cirrhosis (MELD-Na 19), massive right hepatic hydrothorax and hepatopulmonary syndrome who underwent daughter-to-father successful LDLT. Intraoperative events included a diaphragmatic rent with hydropneumothorax, portal vein thrombectomy and 4700 mL blood loss. The postoperative course was complicated by persistent hydrothorax, an acute neuropsychiatric syndrome, catheter-related urinary Enterococcus faecalis infection, and partial thrombosis of the reconstructed middle hepatic vein graft. Everything was resolved due to timely intervention and he was discharged on day 16.