Living liver donor death related to complications of myeloma.

Details

Serval ID
serval:BIB_9021E8B80699
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Title
Living liver donor death related to complications of myeloma.
Journal
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
Author(s)
Melloul E., Dondero F., Paugam-Burtz C., Bouadma L., Arnulf B., Belghiti J.
ISSN
1527-6473 (Electronic)
ISSN-L
1527-6465
Publication state
Published
Issued date
03/2009
Peer-reviewed
Oui
Volume
15
Number
3
Pages
326-329
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: ppublish
Abstract
We report a donor death after right hepatectomy for living donor transplantation due to an undiagnosed myeloma. The 47-year-old donor, who was the 147th case performed in our department, was in excellent health without any abnormalities in the preoperative investigations. Despite an uneventful right hepatectomy without transfusion, the patient developed a partial thrombus of the inferior vena cava with a right proximal pulmonary trunk embolism on postoperative day 6. Subsequently, he developed multiorgan dysfunction leading to a coagulopathy, respiratory distress, and renal failure requiring hemodialysis and mechanical ventilation. This clinical scenario led us to suspect a hematological disorder. Immune electrophoresis showed a monoclonal peak of immunoglobulin G (8.7 g/L), a myelogram revealed an abnormally high level of dystrophic plasmocytes (more than 7%), and biopsies of salivary glands confirmed the diagnosis of immunoglobulin G kappa myeloma. The patient progressively deteriorated because of simultaneous hemorrhagic and infectious pulmonary complications resulting in septic shock. Despite an adequate combination of antimicrobial therapy and pleural drainage, the donor died on postoperative day 57 from multiple organ failure. This unusual cause of donor death after right hepatectomy reinforces the need for an extensive preoperative assessment. We advocate the addition of urinary protein loss and electrophoresis to the standard donor assessment protocol.

Keywords
Fatal Outcome, Humans, Liver/anatomy & histology, Liver Cirrhosis, Alcoholic/surgery, Liver Function Tests, Liver Transplantation/physiology, Living Donors/statistics & numerical data, Male, Middle Aged, Multiple Myeloma/mortality, Treatment Outcome
Pubmed
Create date
15/02/2017 11:51
Last modification date
20/08/2019 15:53
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