Liver transplantation for acute liver failure: Analysis of applicability

Castells, Antoni; Salmerón, Joan Manuel; Navasa, Miquel; Rimola, Antoni; Saló, Joan; Andreu, Hernán; Mas, Antoni; Rodés, Joan

doi:10.1016/0016-5085(93)90731-q

Cited by 68 publications

(29 citation statements)

References 16 publications

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“…In this sense, the overall survival observed in our patients was 58% (35% increase in survival from that expected without emergency OLT). By using the classical King's College criteria for emergency OLT in all centers except one, which applies another previously reported score, 17 patients who were not transplanted because they did not fulfill these criteria had an excellent survival (85.5%, Table 1). Moreover, death in this group of patients (8 cases) was due to extrahepatic causes.…”

Section: Discussionmentioning

confidence: 73%

“…Candidacy for LT was determined at each individual center according to the King's College Guidelines 16 except for one center, which used the following criteria to define the need for LT: grade III or IV of HE regardless of the patient's clinical evolution; progression of encephalopathy after a transient period of improvement; and absence of improvement after a 3-day period of supportive management in patients with subfulminant ALF and grade I or II HE. 17 Spontaneous survival was defined as survival without OLT.…”

Section: Methodsmentioning

confidence: 99%

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Acute liver failure in Spain: Analysis of 267 cases

2007

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The cause of acute liver failure (ALF) is a major determinant of its outcome. Acetaminophen (paracetamol) overdose is a leading cause of ALF in some developed countries, whereas in others, such as Spain, it is extremely rare. To analyze the etiology, characteristics, and outcome of ALF in Spain, we performed a retrospective analysis of 267 patients whom we observed from 1992 to 2000. Seventeen tertiary-care hospitals with active liver transplantation (LT) programs contributed data. Causes of ALF were viral hepatitis in 98 (37%; hepatitis B virus in 75 patients), unknown in 86 (32%), drug or toxic reactions in 52 (19.5%; acetaminophen overdose in 6), and miscellaneous in 31 (11.6%). Overall survival was 58%. LT was performed in 150 patients, with a survival of 69%. Despite fulfilling criteria, 51 patients were not transplanted because of contraindications; their survival was only 7.8%. Forty-seven (85.5%) of 55 patients without transplant criteria survived. Hepatitis B virus is the most common cause of ALF in Spain, although the origin of 30% of cases remains undetermined. Acetaminophen overdose represents a very rare cause of ALF. LT was performed in Ͼ50% of cases. Patients without transplant criteria had a very good prognosis; those who fulfilled these criteria but who had contraindications for transplantation had a high mortality rate. Liver Transpl 13:1389Transpl 13: -1395Transpl 13: , 2007

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Section: Discussionmentioning

confidence: 73%

Section: Methodsmentioning

confidence: 99%

Acute liver failure in Spain: Analysis of 267 cases

2007

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“…[6][7][8] Nonetheless, the application of OLT among patients with ALF has remained low, which suggests that the full potential of this modality is not being realized. 9 In the United States, as in other countries, patients with ALF have the highest priority for donor organs, and currently 6% of all liver transplantations in adults and 11% in children are performed for ALF. 10,11 Early determination of prognosis and prompt decision making regarding transplantation are clearly important in such patients.…”

Section: Study Of Liver Diseasesmentioning

confidence: 99%

Acute liver failure: Clinical features, outcome analysis, and applicability of prognostic criteria

Shakil¹,

Kramer²,

et al. 2000

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Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. We performed a retrospective analysis of patients evaluated for ALF. The aim of our study is to determine the clinical features and outcome of such patients and to assess the validity of King's College Hospital (KCH) prognostic criteria. One hundred seventy-seven patients were evaluated for ALF during a period of 13 years. Mean age was 39 years, and 63% were women. The causes included viral hepatitis (31%), acetaminophen toxicity (19%), idiosyncratic drug reactions (12%), miscellaneous causes (11%), and an indeterminate group (28%). Twenty-five patients (14%) recovered with medical therapy (group I), 65 patients (37%) died without orthotopic liver transplantation (OLT; group II), and 87 patients (49%) underwent OLT (group III). Patients in group II were older and often had advanced encephalopathy, whereas those in group I had less hyperbilirubinemia and often had hyperacute failure. KCH criteria had high specificity and positive predictive value but low negative predictive value for a poor outcome. We conclude that early prognostication is needed in patients with ALF to assist decision making regarding OLT. The fulfillment of KCH criteria usually predicts a poor outcome, but a lack of fulfillment does not predict survival.

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“…Later causes of postoperative deaths were bacterial and fungal infections (n = 11) or necrotizing pancreatitis (n = 1). Cytomegalovirus or herpes virus pneumonias (n = 2), peritonitis (n = I), chronic rejection (n = I), or carcinoma recurrence (n = 1) were the causes of 5 late deaths (2,8,8,9, and 10 months). For the 14 patients who survived 6 months or more, the 6-month Kamofsky score was 66% f 32% (range, 10 to 9OOh).…”

Section: Patient's Outcome After Eltmentioning

confidence: 99%

How valid is emergency liver transplantation for acute liver necrosis in patients with multiple-organ failure?

et al. 1996

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Multiple‐organ failure (MOF), defined as the failure of initially uninvolved organs, is the final step of definitive and massive liver necrosis. Emergency liver transplantation (ELT) has radically modified the outcome of acute liver failure and early primary graft failure, but the results of ELT in cases of MOF are unknown. From May 1988 to June 1993, 243 patients underwent a liver transplantation (LT). Thirty‐seven patients (15.2%) who had an acute liver necrosis complicated by a MOF underwent an ELT. Twenty‐one patients were children. An emergency retransplantation was performed in 16 patients. Three or 4 organ‐system failures (OSF) were present in 13 patients. Before ELT, the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 26.3 ± 5.1. Six‐month and 1‐year survival rates were 37.8% and 25.9%, respectively, after ELT complicated by MOF, and 78% and 73.5%, respectively, in other cases of LT. Twenty‐six patients had surgical complications (70%), whereas thirty‐one patients had medical complications (84%). Twentytwo patients died during the postoperative period (60%). Before ELT, infection (P < .05), cardiovascular failure (P < .03), and more than two OSF (P < .05) were more frequent in patients who died after intervention. The APACHE II score (P < .05) and the length of stay in the intensive care unit before ELT (P < .05) were lower among survivors. In the context of liver allograft shortage, our results suggest that an ELT should not be performed in patients with cardiac failure, more than two OSF, or an APACHE II score higher than 30. Copyright © 1996 by the American Association for the Study of Liver Diseases.

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Liver transplantation for acute liver failure: Analysis of applicability

Cited by 68 publications

References 16 publications

Acute liver failure in Spain: Analysis of 267 cases

Acute liver failure in Spain: Analysis of 267 cases

Acute liver failure: Clinical features, outcome analysis, and applicability of prognostic criteria

How valid is emergency liver transplantation for acute liver necrosis in patients with multiple-organ failure?

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