Liver Transplantation Due to Fulminant Liver Failure Secondary to Acute Submassive Necrosis in a Patient Treated with Orlistat

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Abstract

Clinical case

A 42 year old man with hypertension under medical treatment. Obese, with a height of 183 cms and 131 Kg, with a body mass index of 39.12. Diagnosed of liver steatosis, in treatment with hypocaloric diet and Orlistat 240 mg / day. 3 months after starting treatment, he suffered a Fulminant Liver Failure with coagulopathy, oliguria and grade II-III encephalopathy. Despite conservative treatment, he clinically worsens substantially, being submitted for an urgent liver transplant. In the postoperative period, a reintervention is done because a severe hypovolemic shock finding an important hemoperitoneum secondary to a bleeding of a little branch dependent of the hepatic artery of the donor. After a favorable postoperative, on the 26th day post-transplant the patient is discharged in good conditions. One year later, a Roux-en-Y Hepaticojejunostomy is performed because an important cholestasis due to a stenosis of the bile duct at the level of the choledochal-choledochal anastomosis, after a failed attempt of endoscopic resolution. Currently uncomplicated with a standard of living acceptable 8 years after the transplant.

Conclusion

Obesity has become a major health problem and Orlistat is currently an available drug of proven effectiveness. Although the direct cause of this drug with the development of a Fulminant Liver Failure is not demonstrated, it is assumed that they would be involved in idiosyncrasy mechanisms. Therefore, we believe that we should be aware of this possibility and closely monitor patients who have steatosis with signs of hepatic dysfunction.

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