Liver Transplantation for Acute-on-Chronic Liver Failure Associated With Acute Necrotizing Pancreatitis: A Case Report

Transplant Proc. 2021 May;53(4):1303-1307. doi: 10.1016/j.transproceed.2021.02.008. Epub 2021 Mar 26.


Liver transplantation (LT) for acute-on-chronic liver failure (ACLF) accompanied by acute necrotizing pancreatitis is still unclear. We have a reported case of LT for ACLF associated with acute necrotizing pancreatitis. The postoperative multiorgan dysfunction and secondary infection were successfully managed under close supervision. The patient was a 47-year-old man with chronic hepatitis B virus infection presented with ACLF and acute necrotizing pancreatitis. After receiving LT from a deceased donor, the patient's liver functioning rapidly reverted to a normal level, and the acute pancreatitis was simultaneously stabilized. However, the patient later developed multiorgan dysfunction secondary to multidrug resistant bacteria infection, which was treated successfully with repeated percutaneous drainage, sensitive antibiotics, continuous renal replacement therapy, microbial balance, and best supportive care. LT can be considered for ACLF associated with acute necrotic pancreatitis without absolute contraindication. Moreover, we recommend a close observation of possible postoperative severe infection, and cautious multidisciplinary management was needed for the prevention of organ dysfunction.

Publication types

  • Case Reports

MeSH terms

  • Acute-On-Chronic Liver Failure / etiology
  • Acute-On-Chronic Liver Failure / surgery*
  • Atrophy / diagnostic imaging
  • C-Reactive Protein / analysis
  • Hepatitis B, Chronic / complications
  • Hepatitis B, Chronic / pathology
  • Humans
  • Liver / pathology
  • Liver Cirrhosis / diagnostic imaging
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Pancreatitis, Acute Necrotizing / complications
  • Pancreatitis, Acute Necrotizing / diagnosis
  • Postoperative Complications
  • Procalcitonin / blood
  • Tomography, X-Ray Computed


  • Procalcitonin
  • C-Reactive Protein