Introduction:
Liver cirrhosis is a common pathology in the mexican population, its main origins are due to NASH or associated with alcohol consumption. Patients with cirrhosis usually have liver disease with failure of other organs such as the kidney and heart. Although the treatment of hepatorenal syndrome seeks reversibility at all costs, it is a reality that the definitive treatment is a liver transplant when reversibility is no longer possible. Management with RRT or liver support has become an increasingly common option as a transplant bridging therapy. Unfortunately, the reality of our country does not allow everyone to receive treatment. In this framework we present the following clinical case.
Methods:
A 54-year-old woman diagnosed with cirrhosis, who has completed the liver transplant protocol, goes to the emergency room of our hospital due to an altered state of consciousness and dyspnea. At PE: Tachycardic, hypotensive, polypnea, with severe generalized jaundice with tense ascites. It was admitted to hospital, with the purpose of stabilizing and improving general conditions to continue in the liver transplant protocol. At the moment she presents CHILD-C, MELD 40 scores, with direct hyperbilirubinemia of 23.8 and total bilirrubin of 33.2, anuric with elevated creatinine of 4.2 and BUN 99, and severe metabolic acidosis. Therefore, it was referred to nephrology to evaluate RRT with CRRT variant with liver support therapy as TPE+DPMAS. However, in the next 2 hours, digestive tract bleeding and hemodynamic deterioration were evident, informing the family that a transfer to the ICU and urgent endoscopy was required. The family decides to stop intervention management, taking her home with palliative care. Medically, it is discussed whether we are facing futile treatment and whether the transplant bridging window had closed.
Results:
Patients with terminal organ failure as the liver, lung or heart require a multidisciplinary approach and assessment protocols to determine the feasibility and success of transplantation as a curative treatment. The dual plasma molecular adsorption system (DPMAS) has emerged as a relevant option for transplant bridging therapy, sadly many patients reach advanced stages of the disease, which reduces the feasibility of implementing this advanced therapy in a timely manner.
Conclusion:
Nephrology requires pre and post involvement and also during the transplant, so it is important to know the indications for ECOS (Extracorporeal organ support) with the CRRT platform, a niche in which today the Liver support has evolved significantly.