Liver transplantation for fulminant hepatic failure
N. L. Ascher, J. R. Lake, J. C. Emond and J. P. Roberts
Liver Transplant Service, University of California, San Francisco.
OBJECTIVE: The purpose of this study was to assess outcome after liver
transplantation for fulminant (FHF) and subfulminant (SHF) hepatic failure
and to determine the factors responsible for outcome. PATIENTS AND SETTING:
Thirty-five patients who underwent 42 liver transplantations for FHF and
eight patients who underwent eight liver transplantations for SHF at a
large university medical center were followed up for 1 month to 5 years.
OUTCOME MEASURES: Actuarial patient and graft survival for FHF and SHF were
assessed and compared with the outcome for all patients who underwent liver
transplantation at the same center over the same period (445 transplants in
420 patients). Patients were treated with intracranial pressure monitoring,
aggressive measures to decrease intracranial pressure, and rapid
transplantation. Functional status and recurrent disease were additional
end points. RESULTS: One-year actuarial patient survival rates for FHF and
SHF were 92% and 100%, respectively. Minor neurological sequelae were noted
in two patients. Functional status was excellent. Posttransplant hepatitis
was present in two patients with an original diagnosis of FHF and acute
hepatitis B and in three patients with an original diagnosis of FHF and
non-A, non-B, non-C hepatitis. CONCLUSION: Patients with FHF and SHF can
achieve excellent results after liver transplantation. Rapid assessment of
candidacy with monitoring of intracranial pressure and aggressive treatment
for intracranial hypertension are thought to be essential in the outcome of
these patients.
