Successful Deceased Donor Liver Transplantation with Postoperative Klebsiella Pneumonia Treatment

Chief Complaints

A 52-year-old female patient with a body mass index (BMI) of 21 presented to the Liver Transplant Department at PACE Hospitals, Hitech City, Hyderabad, with jaundice and recurrent episodes of intermittent fever for the past 4 months.

The patient was a known case of decompensated chronic liver disease. Liver biopsy findings were suggestive of advanced liver cirrhosis, possibly related to non-alcoholic steatohepatitis. She also had chronic obstructive pulmonary disease (COPD) as an associated medical condition.

On examination, the patient was conscious, coherent, oriented, and hemodynamically stable. Evident icterus was noted, with yellowish discoloration of the eyes. She appeared clinically unwell in the background of decompensated chronic liver disease and recurrent fever. A complete abdominal, cardiovascular, respiratory, and neurological examination was performed as part of the liver transplant assessment.

Upon admission to PACE Hospitals, the Liver Transplant team conducted a comprehensive evaluation based on the patient’s complaints of persistent jaundice and intermittent fever in the background of known decompensated chronic liver disease.

A detailed medical history, physical examination, laboratory investigations, imaging studies, and liver biopsy were performed to assess the severity and possible cause of liver damage. The liver biopsy showed distorted liver architecture with complete nodular formation and fibrous bands containing inflammatory cells, findings consistent with advanced liver cirrhosis.

Based on the clinical and biopsy findings, the patient was diagnosed with decompensated liver cirrhosis, possibly secondary to non-alcoholic steatohepatitis. Chronic obstructive pulmonary disease was also considered during the pre-transplant evaluation.

Based on the confirmed diagnosis and severity of liver dysfunction, the patient was advised to undergo Decompensated Liver Cirrhosis Treatment in Hyderabad, India, under the specialised care of the Liver Transplant Department.

After a detailed consultation with Dr. CH Madhusudhan (Senior Consultant Surgical Gastroenterologist and Liver Transplant Surgeon), and cross consultation with Dr. Govind Verma (Senior Consultant Interventional Gastroenterologist and Hepatologist) and Dr. Suresh Kumar S (Consultant Surgical Gastroenterologist), the patient underwent a comprehensive clinical, laboratory, imaging, and pre-anaesthesia evaluation. Her history of persistent jaundice, intermittent fever, decompensated chronic liver disease, biopsy-confirmed cirrhosis, and associated chronic obstructive pulmonary disease was carefully reviewed to determine the most appropriate treatment plan.

Considering the advanced liver damage and risk of further life-threatening complications, the liver transplant team determined that liver transplantation was the most appropriate definitive treatment. As no suitable living donor was available within the family, the patient was registered under the Jeevandan deceased organ donation programme in Telangana.

When a suitable deceased donor liver became available, compatibility, recipient fitness, and necessary medical clearances were assessed. The patient was stabilised and prepared for Deceased Donor Liver Transplantation.

The patient and her family were counselled regarding the severity of the liver disease, the transplant procedure, possible risks and complications, postoperative intensive care, infection and rejection risks, long-term anti-rejection medicines, and the importance of regular follow-up after transplantation.

Following the decision, the patient was scheduled to undergo Deceased Donor Liver Transplantation (DDLT) in Hyderabad at PACE Hospitals under the expert care of the Liver Transplant team.

The procedure involved the following steps:

• Preoperative Preparation and Anaesthesia: After completing the required investigations, donor compatibility assessment, medical clearances, and pre-anaesthesia evaluation, the patient was taken up for transplantation under general anaesthesia with continuous monitoring.

• Abdominal Exploration and Liver Mobilisation: The abdominal cavity was accessed, and the diseased liver was carefully assessed and mobilised from the surrounding structures while controlling bleeding and protecting nearby organs.

• Removal of the Diseased Liver: The major blood vessels and bile duct connected to the native liver were carefully identified and controlled. The severely damaged liver was then removed to prepare the recipient site for transplantation.

• Donor Liver Graft Implantation: The deceased donor liver graft obtained was positioned in the recipient’s abdomen.

• Vascular and Biliary Reconstruction: The donor liver blood vessels were connected to the recipient’s vessels to restore blood flow to the graft. The bile duct was reconstructed to allow normal drainage of bile from the transplanted liver.

• Graft Assessment and Closure: After confirming satisfactory graft perfusion and controlling bleeding, the abdomen was closed in layers. The procedure was completed without reported intraoperative complications, and the patient was shifted to the intensive care unit for close postoperative monitoring.
  

After surgery, the patient was closely monitored for transplanted liver function, blood clotting, breathing, infection, and overall recovery. She later developed fever, cough with sputum, and required prolonged oxygen support. Sputum culture identified Klebsiella pneumoniae infection, which was treated with appropriate medical management under specialist care.

She received medicines to protect the transplanted liver and prevent rejection, control infection, provide gastric protection, support nutrition, prevent vomiting, and relieve pain and fever. Anti-rejection medicine doses were adjusted according to liver function test results. After clinical improvement and hemodynamic stabilisation, she was discharged with medications and follow-up advice.

Upon discharge, the patient was advised to take medicines to protect the transplanted liver and prevent rejection, along with medicines to treat and prevent infection. She was also prescribed medicines for gastric protection, nutritional support, nausea control, pain relief, fever control, and other supportive care.

The patient was advised to take all medicines on time, maintain proper hygiene, avoid exposure to infections, and follow the liver transplant team’s instructions carefully. Regular follow-up was advised to monitor liver function, respiratory recovery, and anti-rejection medicine levels.

The patient was advised to contact the emergency ward at PACE Hospitals in case of the development of symptoms such as fever, worsening cough, breathing difficulty, abdominal pain, repeated vomiting, worsening jaundice, confusion, bleeding, reduced urine output, wound-related concerns, or any sudden deterioration in her condition.

The patient was advised to return for a follow-up visit with the Surgical Gastroenterologist in Hyderabad at PACE Hospitals to monitor transplanted liver function, respiratory recovery, infection status, wound healing, and anti-rejection medicine levels.

This case highlights the successful management of decompensated liver cirrhosis through Deceased Donor Liver Transplantation. The postoperative Klebsiella pneumoniae respiratory infection was identified and treated promptly, following which the patient improved and was discharged in a stable condition with medications and follow-up advice.