Adult respiratory distress syndrome associated with acute liver allograft rejection: Resolution following hepatic retransplantation

The adult respiratory distress syndrome (ARDS) is a pulmonary expression of multiple extrapulmonary organ system failures; the extent of such failures increases the mortality in patients with ARDS. Extrapulmonary organ dysfunction may also modulate the severity and potential for recovery from acute lung injury during critical illness. Despite this, the mechanisms by which these interactions may affect outcome from ARDS are poorly understood. Furthermore, there are no data to determine whether selective improvement of an individual failing extrapulmonary organ system enhances resolution from the established ARDS. The liver is a key organ in several host-defense systems relevant to the pathogenesis and perpetuation of acute lung injury. Recently, we found an increased incidence of nonresolving ARDS in patients with end-stage liver failure awaiting hepatic transplantation. In the patient described below, we observed the acute effect of selective hepatic replacement on the clinical course of ARDS associated with severe liver allograft rejection.