Septic pulmonary embolism originated from subcutaneous abscess after living donor liver transplantation: a pitfall of postoperative management

An intensive medical care network led to successful living-donor liver transplantation in late-onset hepatic failure with disseminated Staphylococcus aureus infection

Here, we describe a 42-year-old male patient with late-onset hepatic failure (LOHF) due to acute-onset autoimmune hepatitis. At first, his response to steroid therapy was good, but hepatitis relapsed during steroid pulse therapy. Deterioration of liver function caused LOHF, and LOHF has a poor prognosis, particularly when it is complicated by infection. Systemic infection by Staphylococcus aureus resulted in a skin rash and septic pulmonary embolism, and is an absolute contraindication for liver transplantation (LT). In this treatment network, hepatologists and a transplant surgeon cooperated to overcome severe infection and their efforts led to successful transplantation. On-line hemodiafiltration is an indispensable treatment option for acute liver failure. Infection control is crucial for LT and an intensive medical care network led to successful living-donor LT.