Introduction

The potential risk of hepatotoxicity of Isoniazid (INH), Rifampicin (RMP) and Pyrazinamide (PZA) in the first-line treatment of tuberculosis has been described extensively. Despite of this, fulminant liver failure (FLF) due to toxic causes is an exceptional entity in paediatrics, with a rapidly progressive course and poor prognosis. The only therapy in most cases is transplantation, a treatment considered to be the "gold standard" that increases survival to more than 60% in one year. We present a case of FLF due to antituberculous treatment in a 12-year-old boy, who required auxiliary orthotopic liver transplant (AOLT).

Case description
A 12-year-old male from Bolivia, with no relevant past medical history, presented with a 2 weeks of productive morning cough associated with fever, night sweats and poor general condition. 
Chest x-rays showed a cavitated multilobar pneumonia, suggestive of tuberculosis.
After initiating antituberculous treatment, he presented FLF with coagulopathy and severe encephalopathy.  An organ for transplant was urgently requested.

Surgical technique
-A reduced organ was used, by implanting left liver, eliminating segments IV, II and III.
-The graft was implanted in the right upper quadrant, with the hilum located medially and the posterior vena cava.
-The inferior vena cava of the donor was attached end-to-side with the receptor´s cava, in the highest possible situation.

Evolution
After surgery, the child presented progressive improvement of general condition despite neurological sequelae with 6º pair palsy and right hemiparesis that resolved.
-Liver function tests showed decreased ALT/AST and bilirubin, associated with increased hepatic synthesis (graphs).
- Hepatic biopsy 15 days post-transplant, reports viability of native liver without signs of regeneration and acute rejection of the donor organ, which was treated with corticosteroids.

Conclusions
AOLT is a safe therapeutic alternative in paediatric patients with active tuberculosis and FLF secondary to antituberculous treatment. Immunosuppression and the reintroduction of tuberculostatic drugs are a challenge to avoid new complications.

09 / AUXILIARY HEPATIC TRANSPLANT IN A PEDIATRIC PATIENT FOR HEPATIC FAILURE SECONDARY TO TUBERCULOSIS TREATMENT