Liver Coma: Causes, Risks, and Transplant Options - Gastroenterology and Hepatology

Hepatic coma

My sister is currently in Canada.
Last week, she mentioned that her eyes were yellow and her urine was also yellow.
On the 23rd, she felt unwell and was taken to the emergency room.
The doctors have diagnosed her with gallstones and hepatic encephalopathy.
She is about seven months pregnant, and on March 23rd, she delivered the baby prematurely, who is now in an incubator.
On the 24th, she was still stable, but by the 25th, she had entered a semi-comatose state.
The doctors are unable to determine the cause and are currently monitoring her.
If her liver enzymes remain very high, a liver transplant may be necessary.
She has never had liver issues before, and we are unsure how to address this sudden situation.

If a liver transplant is required, is it more likely that a sister would be a suitable donor? Does the donor need to have the same blood type? My sister has an Rh-negative blood type; does the donor need to match this as well? How can we assist her from Taiwan? If a liver transplant is indeed necessary, would it be better for her to return to Taiwan for the procedure?

lily, 30~39 year old female. Ask Date: 2008/03/27

Dr. Li Xuanshu reply Gastroenterology and Hepatology

Hello! Although it is unclear what caused your sister's acute liver failure, based on the information in the letter, liver transplantation must be considered.
We strongly recommend consulting with a physician in Canada regarding the possible causes of your sister's condition.
Could it be related to her pregnancy? There are many factors that can lead to liver disease in pregnant women, especially in the third trimester.
In terms of liver transplantation, a direct blood relative is preferable, but collateral relatives can also be considered.
Generally, it is advised that matching blood types is best, as this can reduce the risk of rejection.
Family members in the country may have limited assistance, and currently, the focus should be on closely monitoring your sister's condition.

Reply Date: 2008/03/27

More Info

Liver coma, also known as hepatic encephalopathy, is a serious condition that can arise from liver failure, leading to a decline in brain function due to the accumulation of toxins in the bloodstream. Understanding the causes, risks, and potential transplant options is crucial, especially in the context of your sister's recent health crisis.

Causes of Liver Coma
Liver coma can be triggered by several factors, including:
1. Acute Liver Failure: This can occur due to viral hepatitis, drug-induced liver injury (such as from acetaminophen overdose), or other acute liver diseases.

2. Chronic Liver Disease: Conditions like cirrhosis can lead to a gradual decline in liver function, eventually resulting in hepatic encephalopathy.

3. Bile Duct Obstruction: As in your sister's case, gallstones can block the bile ducts, leading to jaundice (yellowing of the skin and eyes) and liver dysfunction.

4. Infections: Severe infections can exacerbate liver conditions and lead to hepatic encephalopathy.

5. Metabolic Disturbances: Electrolyte imbalances, particularly low sodium levels, can also contribute to the development of liver coma.

Risks Associated with Liver Coma
The risks of liver coma include:
- Neurological Damage: Prolonged hepatic encephalopathy can lead to irreversible brain damage.

- Multi-Organ Failure: The liver plays a critical role in detoxifying the blood; failure can lead to systemic complications.

- Increased Mortality: The prognosis for patients with liver coma is often poor, particularly if the underlying cause is not addressed promptly.

Liver Transplant Options
In cases where liver function is severely compromised, a liver transplant may be the only viable option. Here are some key points regarding liver transplantation:
1. Eligibility: To be considered for a transplant, your sister would need to be evaluated by a transplant team. Factors such as her overall health, the cause of liver failure, and the presence of other medical conditions will be assessed.

2. Living Donor Transplant: Since you mentioned that you are a sibling, you may be a potential living donor. However, compatibility is crucial. Blood type matching is necessary, and while RH factor (positive or negative) is important, the ABO blood group compatibility is the primary concern.

3. Waiting Lists: If a living donor is not available, your sister may be placed on a waiting list for a deceased donor liver. The waiting time can vary significantly based on organ availability and the urgency of her condition.

4. Transplant Centers: If considering a transplant, it is essential to consult with a reputable transplant center. In Taiwan, there are several centers with experience in liver transplantation.

Considerations for Transplantation in Taiwan
If you are contemplating bringing your sister back to Taiwan for a liver transplant, consider the following:
- Medical Records: Ensure that all medical records and test results are transferred to the new medical team in Taiwan.

- Consultation: Schedule a consultation with a liver transplant team in Taiwan as soon as possible to discuss her case and potential options.

- Logistics: Consider the logistics of transporting her back, especially given her current health status and the need for ongoing medical care.

Conclusion
Your sister's situation is indeed critical, and timely intervention is essential. The possibility of a liver transplant should be discussed with her medical team in Canada, and if deemed necessary, arrangements can be made for her to receive care in Taiwan. It is vital to act quickly, as the condition can deteriorate rapidly. Stay in close contact with her healthcare providers, and ensure that you are informed about her treatment options and the potential for a liver transplant.

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