1.

A 57 years old male patient was admitted at the surgical ward unit with chief complain of yellowish
color of the eyes and skin, dark colored urine, swelling of legs and ankles, abdominal pain and swelling,
central arteriole with tiny radiating vessels, mainly on trunk and face and fatigue. Upon the history
taking the patient is a chronic alcohol abuser and smoker for 25 years, with comorbidity of hypertension
and diabetes mellitus type II but his not taking maintenance medications on an everyday basis. He has a
family history of liver cancer from his paternal side. Patient weigh 110kg, height of 5’6. Upon admission
the patient’s vital signs are as follows BP 140/90 PR 109 RR 28 Temp 37.3 o2 sat 95%. With ongoing IVF
of Plain NSS 1000CC regulated at 100cc/hr, in oxygen therapy via nasal cannula at 2-3lp. Laboratory
findings revealed AST 450U/L ALT 200U/L bilirubin 2.1mg/dl prothrombin time 9 seconds Sodium 117
meqs/L Potassium 35meqs/L WBC 3.2 RBC 3.9 Hgb 11 Hct 38.1 plt 91, abdominal ultrasonography with
Doppler showed Nodularity, irregularity, increased echogenicity, and atrophy. After 1 day of admission
in the surgical private room the patient and his wife consented for liver biopsy via laparoscopic and the
result revealed end stage liver disease caused by biliary cirrhosis, the doctor scored the patient as high
MELD indicates an urgent need of transplant. The patient was discharged while waiting for a liver donor.

2. The 57-year-old male underwent orthotopic liver transplantation from a 59-year-old cadaveric donor
(cause of death was an intracranial hemorrhage) for end-stage liver disease caused by biliary cirrhosis.
The biliary anastomosis was accomplished with a choledochojejunostomy. The transplant operation was
technically difficult, with the requirement of 29 units of blood (all blood used was from cytomegalovirus
seronegative donors). Because of continued bleeding, the surgeons reexplored the patient the second
day after transplant to drain a hematoma and to assure future hemostasis. After the procedure, the
patient became quite stable, the patient was discharged. 14 days after transplant patient was on an
immunosuppressive regimen that included tacrolimus, mycophenolate, and prednisone after an
induction course of antilymphocyte globulin. Antimicrobial prophylaxis included trimethoprim-
sulfamethoxazole, acyclovir, and fluconazole. The patient remained well until 7 weeks after transplant.