Fatal Hyperammonemia after Orthotopic Lung Transplantation

Article Abstract:

Some patients who receive a liver transplant may develop hyperammonemia, which could be fatal. Hyperammonemia is the medical term for excessive ammonia levels in the blood. Normally, the liver converts ammonia to urea, which is then excreted in urine. Too much ammonia in the blood can be toxic, especially to the brain. In a study of 145 patients who received a liver transplant, six developed hyperammonemia. Two-thirds died, compared to 17% of those who did not develop hyperammonemia.

Organ transplant recipients

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Primary hepatocellular carcinoma after orthotopic liver transplantation for chronic hepatitis B infection

Article Abstract:

Chronic infection with hepatitis B virus may be complicated by end-stage (advanced) liver disease that can be treated by liver transplantation. However, the virus infects the new liver in most recipients, who ultimately develop chronic hepatitis B and cirrhosis, a chronic disease of the liver characterized by abnormal structural changes, loss of liver cell function, and resistance to blood flow through the liver. Chronic hepatitis B increases the risk of liver cancer. A case is described of a 42-year-old man with chronic active hepatitis B who received a liver transplant for progressive liver failure. The patient developed primary hepatocellular carcinoma (liver cell cancer) within four years of infection of the graft. (Liver cancer usually takes 20 years to develop in the average patient with chronic hepatitis B infection.) The weakened immune system of the liver transplant recipient may have contributed to the rapid development of liver cancer. Chronic hepatitis B infection worsens after start of immunosuppressive therapy in infected transplant recipients. Studies show that corticosteroid agents, which are given to transplant recipients to suppress the immune system in an effort to prevent graft rejection, may improve measures of liver function, but may also increase viral activity in patients with chronic hepatitis B infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Causes of, Hepatitis B, Liver cancer

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Hepatic glutamine synthetase deficiency in fatal hyperammonemia after lung transplantation

Article Abstract:

Two patients who developed a rare but fatal complication called hyperammonemia following lung transplantation were found to have deficiencies in a liver enzyme, glutamine synthetase. Hyperammonemia is excess ammonia in the blood, and it resulted in the brain death of both women. The cause of this condition in these patients, and in other transplantation and chemotherapy cases, is not known. Glutamine synthetase in the liver is required to remove ammonia from the blood. The deficiencies detected in these two patients may provide insight as to the cause of the hyperammonemia observed.

Lungs, Metabolic diseases, Lung transplantation

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