54 year male patient, known case of HBV related HCC, s/p liver transplant in 2021, two years he was disease free. In June 2023, he developed an acute antibody-mediated rejection(ABMR) taken treatment for it in Bengaluru. Presented to Vivekanand General Hospital Hubli,with acute decompensated liver failure , AKI, massive left pneumothorax and pneumonia .Immediately ICD was inserted and the patient was stabilised. On evaluation found to have cytokine storm.He was started on broad spectrum antibiotics and antifungals . The ideal treatment for this is MARS(Molecular Adsorption Recirculating System), but it’s too expensive and not easily made available in this part of Karnataka. So after discussing with the medical gastroenterologist, it was decided to go ahead with DPMAS (Double Plasma Molecular Adsorption System). It needs a special filter(liver filter) BS330 . Two HD machines connected in series, in one machine plasma is removed and in the second machine bilirubin and bile salts are removed, remaining plasma and blood directed to the patient. He underwent 3 sessions of DPMAS. His initial total bilirubin was 38.5 , after each session( 4 hours)around 60% bilirubin was removed and every time around 10% bilirubin rebounded the next day . At the time of discharge his bilirubin was 12.5. He was stable at the time of discharge.
He advised to undergo a second liver transplant soon.
It was a team effort, including Medical Gastroenterologist, Pulmonologist, Intensivists, Dialysis technicians, Nursing staff and special thanks to our CEO Mr Rahul.
Dr Shidram Kamate
Nephrologist and Transplant Physician.
Vivekanand General Hospital
Hubli.
Karnataka.
