Liver transplantation for fulminant hepatic failure

Abstract

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.