ABSTRACT
Mucormycosis, a group of opportunistic mycoses caused by Mucorales, present a significant threat to immunocompromised patients. In this report, we present the case of a 57-year-old male patient who underwent liver transplant for secondary biliary cirrhosis following inadvertent bile duct injury. Despite initial satisfactory postoperative evolution, the patient developed fever, and imaging revealed a suspicious lesion. Preliminary culture growth suggested a filamentous fungus, leading to initiation of liposomal amphotericin B. However, the lesion progressed, and a surgical debridement was necessary. During surgery, involvement of the liver dome and diaphragm was observed, and a nonanatomical hepatectomy was performed. Despite efforts, the patient's condition deteriorated, ultimately resulting in multiple organ failure and mortality. This case emphasizes the challenging nature of mucormycosis in livertransplant recipients.
Subject(s)
Antifungal Agents , Immunocompromised Host , Liver Cirrhosis, Biliary , Liver Transplantation , Mucormycosis , Humans , Male , Mucormycosis/diagnosis , Mucormycosis/microbiology , Mucormycosis/immunology , Mucormycosis/drug therapy , Mucormycosis/etiology , Middle Aged , Liver Transplantation/adverse effects , Antifungal Agents/therapeutic use , Fatal Outcome , Liver Cirrhosis, Biliary/surgery , Liver Cirrhosis, Biliary/microbiology , Liver Cirrhosis, Biliary/diagnosis , Treatment Outcome , Opportunistic Infections/microbiology , Opportunistic Infections/immunology , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Debridement , Allografts , Hepatectomy , Amphotericin B/therapeutic use , Amphotericin B/administration & dosage , Multiple Organ Failure/etiology , Multiple Organ Failure/microbiologyABSTRACT
Portal vein thrombosis is a common complication in patients with cirrhosis and a challenge for the transplant team. Not so long ago, portal vein thrombosis was considered an absolute contraindication for liver transplant, but improvements in surgical techniques have overcome this problem in many transplant centers around the world. Here, we present the case of a 52-year-old female patient with cirrhosis from a primary biliary cholangitis and a complex portal vein thrombosis. She underwent a deceased donor liver transplant with a Model for End-Stage Liver Disease of 40. The portal thrombosis was handled using a portosystemic shunt from the splenic vein to the left ovarian vein, which was visualized on a computed tomography scan performed as part of the study protocol. The donor was a 52-year-old woman with brain death secondary to a vascular cerebral accident. A caval replacement technique was used with no complications during surgery. For the portal anastomosis, the dilated left ovarian vein was carefully dissected and brought through the lesser sac, behind the stomach, to obtain a suitable length. An end-to-end anastomosis of the graft portal vein to the left ovarian vein was performed with a 6-0 Prolene running suture. An abdominal computed tomography scan was performed 6 months after liver transplant showing patency of portal vein and no anastomotic defects, and after 24 months of follow-up the patient is in good clinical condition with normal laboratory values and Doppler ultrasonography with no vascular anomalies and adequate portal flow. To our knowledge, the use of a spleno-ovarian shunt has not been reported as an alternative for portal reconstruction in a case of thrombosis.
