Acute and subacute fulminant hepatic failure: the role of liver transplantation

Abstract

Objectives To report the experience of the Australian National Liver Transplant Unit with patients with fulminant hepatic failure and to describe the role of liver transplantation. Patients: Twenty‐seven patients presented with acute or subacute fulminant hepatic failure during the period from January, 1986, to March, 1990. Twenty‐two had acute arid five had subacute fulminant hepatic failure. The causes were hepatitis B in 10 patients, presumed non‐A, non‐B {NANB) hepatitis in eight patients, drug‐induced hepatic damage in five patients, and Wilson's disease in four patients. There were 13 males and 14 females. Ages were 2–43 years (mean, 23). Twenty patients (74%) were in grade IV encephalopathy on presentation. Results Six patients (22%) began to improve soon after admission and went on to full recovery. Spontaneous recovery was more frequent in patients with drug‐induced hepatic damage (four patients [80%]) and was less frequent in those with hepatitis B (one patient [10% and NANB hepatitis (one patient [12%. The other 21 patients (78%) were considered for orthotopic liver transplantation. Eight (30%) were judged to be unsuitable and went. on to early death. Thirteen (48%).were suitable for transplantation. Of these five (19%) died before a liver donor became available and eight (30%) received liver grafts and went. on to full recovery. Overall, 14 patients (52%) survived and 13 (48%) died. Patients with Wilson's disease (four [100% were most suitable for orthotopic liver transptantatlon whereas eight (44%) of those with hepatitis B or NANB hepatitis were unsuitable. Of the eight patients receiving liver grafts one. had hepatitis B, three had NANB hepatitis and four had Wilson's disease. Five were in grade IV encephalopathy at the time of operation. The mean waiting time for transplantation was 6.4 days. Five patients received ABO blood group compatible grafts and three received ABO incompatible grafts. Of the latter group, two subsequently required secondary orthotopic liver transplantation with ABO compatible grafts. All eight patients who received transplants are alive and well 3–24 months after the operation. No patient has any neurological sequelae. Conclusions Orthotopic liver transplantation is a preferred option. for patients with fulminant hepatic failure whose condition is not responding to conservative management. ABO incompatible livers transplanted in emergency circumstances may prove lifesaving either by functioning successfully or by providing time during which ABO compatible grafts become available. Despite the availability of liver transplantation, many patients with fulminant hepatic failure in Australia still die, some before hepatic transplantation can be undertaken. Early referral of patients with fulminant hepatic failure to established centres with liver transplantation programmes is required.

Etiology and outcome of fulminant hepatic failure managed at an Australian liver transplant unit

“…The majority of cases of FHF in the current series were due to either paracetamol poisoning or NANB hepatitis. In a report of 27 patients with FHF referred for transplantation and managed at the Australian National Liver Transplant Unit in Sydney between 1986 and 1990, 7 there were two cases of paracetamol‐induced FHF, 10 (37%) due to acute hepatitis B, and eight (30%) NANB hepatitis cases reported. The low incidence of paracetamol poisoning in this earlier series is surprising.…”

“…The epidemiology and outcomes of FHF within Australia have not previously been clearly defined 7,8 . The current review was undertaken at the Victorian Liver Transplant Unit based at the Austin and Repatriation Medical Center in Melbourne.…”

“…6 The epidemiology and outcomes of FHF within Australia have not previously been clearly defined. 7,8 The current review was undertaken at the Victorian Liver Transplant Unit based at the Austin and Repatriation Medical Center in Melbourne. The Victorian Liver Transplant Unit is the sole center providing liver transplantation services for the States of Victoria and Tasmania, servicing a population of approximately 5 million people.…”

Acute liver failure in children: A regional experience

“…The only reports of outcome after transplantation for fulminant hepatic failure in this region are from a single centre in Sydney 8−10 . Most of their patients, however, were adults with only four patients in the paediatric age range and none were infants 9 .…”

Treatment of Severe Liver Failure with a Bioartificial Livera

“…Orthotopic liver transplantation (OLT) is the definitive therapy for severe liver failure 1 . However, many patients die before an organ becomes available, mostly from cerebral edema 2 .…”