Case Archive
Transplantation, Liver Transplant
Ref. # 936001

A 21 year old Dominican immigrant with one child and a history of urinary tract infection (UTI) came under the care of a maternity care clinic approximately 26 weeks into her pregnancy. She appeared to have been self-medicating with Macrodantin. Tests showed low hematocrit and moderate leukocytes in her urine. Three days later the woman presented to a primary care physician complaining of gastric pain. He diagnosed dehydration and instructed her to go to the hospital if her discomfort persisted. Five days later the woman presented to the ER with jaundice, backache and painful urination. The woman was discharged with a preliminary diagnosis of UTI. Two days later liver function tests revealed abnormality and the woman was called and readmitted. There was a pre-op diagnosis of fatty liver. Labor was induced and a C-section was performed, delivering a healthy child. The next day the woman's blood glucose was 69 and her PT/PTT was low. The following day her blood ammonia was increasing and an ultrasound confirmed liver failure. Three days later she lapsed into a coma and was transferred to another medical center for a liver transplant. She died after the surgery. A medQuest liver transplantation specialist opined there was a negligent four-day delay in diagnosing fulminant hepatic failure. With timely transfer and transplantation the woman would have survived.

Transplantation, Liver Transplant
Ref. # 89338

A 62 year old Michigan man with a prior medical history of primary biliary cirrhosis, interstitial lung disease, and variceal bleeding was admitted with an acute GI bleed. Blood pressure was 84/60, pulse was 92, hematocrit 22%, and prothrombin times prolonged by 3 to 4 seconds. The patient was transfused with packed cells and FFP. The next day, prior to a planned endoscopy, the patient suffered massive hematemesis, followed by a cardiopulmonary arrest which led to his death. A medQuest transplant surgeon reported that standard of care required a stat endoscopy in light of the abnormal hematocrit value on admission. The patient would have been a good candidate for a liver transplant, assuming it was not contraindicated by the pulmonary disease. Patients with biliary cirrhosis recover well from transplants, with a one-year survival rate of 80-85% and a five-year survival rate of 70-75%.

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