Perioperative management of living donor liver transplantation in a 17-day-old neonate with fulminant hepatic failure

Abstract

We herein report a case of a 17-day-old neonate with fulminant hepatic failure (FHF) who underwent living donor liver transplantation (LDLT) donated by her father. At present, this is the youngest and smallest case of successful LDLT in Japan. She was diagnosed with FHF at the 8th day after her birth. She received repeated plasma exchange (PE) and continuous hemodiafiltration (CHDF) thereafter. She was transferred to our hospital by helicopter at the 16th day after her birth. We performed PE and CHDF again on ICU admission day, and operation was performed on the following day. After the operation, she received continuous hemodialysis for 63 hours due to oliguria. She was then successfully weaned from mechanical ventilation on the 4th post-operative day. Fresh frozen plasma was administered continuously, and for the prevention of the hepatic arterial thrombosis, anticoagulant therapy using mainly nafamostat mesilate was performed. She showed no sign of acute phase rejection and discharged to general ward on the 10th day after admission to ICU.