1228 - Long Term Survival in Patient with Chronic Tetraplegia and Orthotopic Liver Transplantation

Case Diagnosis: Orthotopic liver transplantation (OLT) in an individual with chronic tetraplegia due to traumatic spinal cord injury (SCI)

Case Description: This 69-year-old male initially sustained a C6 ASIA Impairment Scale B SCI in 1977 from a motor vehicle accident during his military service. He was diagnosed with Hepatitis C infection in 1999 and began treatment with Interferon and Ribavirin. He eventually developed end stage liver disease and ultimately underwent OLT in 2006. Upon medical stabilization he was admitted to the SCI/D inpatient unit for further medical monitoring and rehabilitation. Afterwards, the patient enjoyed a period of 17 years without major complications. He continued pursuing his passion for athletics as a Paralympic table tennis player. Through his advocacy and business ventures, he helped improve handicap accessibility in facilities across the San Francisco Bay Area and United States. He served as president of the local Paralyzed Veterans of America chapter and mentored fellow Veterans with SCI. Above all, he remained a devoted husband and father.

Discussions: At the time of this patient’s transplantation, OLT in a person with tetraplegia had not yet been described in the literature. Today, there are still almost no new reported cases. Tetraplegic patients are at higher risk for postoperative complications in the short and long term, most notably pulmonary-related. However, with scant available literature there is concern that patients with tetraplegia may be denied OLT following the transplant risk stratification process. This individual demonstrated remarkable longevity post-transplant, leading a fulfilling life for many years. Therefore, tetraplegia may not significantly increase long term mortality following OLT.

Conclusions: This case demonstrates OLT can be performed successfully in tetraplegic patients with the additional possibility for long-term survival. Individuals with SCI have the potential to lead productive lives post-transplant and SCI should not be considered a contraindication to this procedure.