LIVER-TRANSPLANTATION FOR FULMINANT LIVER -FAILURE AFTER EXERTIONAL HEAT-STROKE

Objectives: Describe the course of fulminant liver failure after exert ional heat stroke. Case report: A 30-year-old man acclimated to the tr opical climate, collapsed and became comatose with hyperthermia during a commando march in Gabon. Thirty-six hours later, the biological exa mination revealed moderate rhabdomyolysis and fulminant liver failure, An orthotoptic liver transplantation was performed at the 48th hour, Acute renal failure with severe rhabdomyolysis developed on the 4th da y post-surgery while the patient was perfectly alert. His condition th ereafter deteriorated and he died of chronic rejection 11 months after liver transplantation. Discussion: In its most serious forms exertion al heat stroke is a multiple organ dysfunction syndrome of poorly unde rstood pathogenesis. The reported case suggests that exertional heat s troke can cause fulminant liver failure, resulting either from the dir ect effect of heat on the hepatic parenchyma, or from acute hepatic is chemia due to blood redistribution made worse by the hypersecretion of antidiuretic hormone, a potent portal vasoconstrictor, which occurs i n the heat acclimated subject.