NEW YORK (Reuters Health) - Over two years ago, the case of a man who died at Mount Sinai Hospital in New York after donating a portion of his liver to his brother gained a lot of media attention. According to a report published this month, fulminant gas gangrene of the stomach was the cause of death.

The healthy 57-year-old man volunteered to give the right section of his liver to his brother in January 2002. The operation and the man's recovery were uneventful until the evening of second day after surgery, when he developed nausea and hiccups.

Early the next day, he seemed well and sat in a chair. Within a few hours, however, he developed a rapidly racing heart, plummeting blood pressure, and vomiting of blood.

Despite efforts to resuscitate him, the patient died.

"Autopsy demonstrated gas gangrene of the stomach as the underlying cause of the hemorrhage and numerous colonies of Gram-positive bacilli were identified," the team that cared for the patient reports in the medical journal Liver Transplantation.

Gas gangrene occurs when severe bacterial infection produces gas from fermentation that permeates surrounding tissue, causes widespread tissue damage, and leads to toxic shock.

The lead author of the report, Dr. Charles M. Miller, is now chief of liver transplantation at the Cleveland Clinic Foundation in Ohio.

Miller and his colleagues report that, on the first day after surgery, the patient was feeling so well that he asked his family to bring him takeout food from a local restaurant. The team speculates that "it is most likely that infection resulted from bacteria in the lobster dinner" from the restaurant, based on the type of bacteria identified.

The man's stomach may have been unable to ward off massive infection because of the surgical stress, a drop in blood supply to the stomach because of the diminished liver size, and the fact that he had been given gastric-acid suppressing drugs, the clinicians suggest. Stomach acid usually kills bacteria.

In the year following this patient's catastrophic death the number of living donor liver transplants in the United States fell by 30 percent compared with the year before, as a result of "national and international media furor, and the rumors and speculations generated in the medical community and the general public."

Now, "We have presented the facts," Miller and his colleagues write.

"Whether or not this death was preventable will remain unknown," they conclude.

Nevertheless, they say it is "reasonable" to avoid oral intake of food for living partial-liver donors immediately after surgery, and to discontinue acid-blocking medications before resuming a regular diet.

SOURCE: Liver Transplantation, October 2004.

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