Orthotopic Liver Transplantation in Fulminant and Subfulminant Hepatitis The Paul Brousse Experience

Abstract

ObjectiveThe authors report on the experience of orthotopic liver transplantation in fulminant hepatitis at Paul Brousse Hospital. Summary Background DataLiver transplantation is a breakthrough in the treatment of patients with fulminant hepatitis. However, the indications, the timing for transplantation, the type of transplantation, and the use of ABO incompatible grafts in this setting still are debated. MethodsTransplantation was indicated in patients with confusion or coma and factor V less than 20%, younger than 30 years of age, and confusion or coma and factor V less than 30% older than 30 years of age. ResultsAmong 139 patients who met the aforementioned criteria for transplantation, 1 recovered, 22 died before transplantation, and 1 16 underwent transplants with a 1-year survival of 68%. Survival was 83% in patients with grade 1 and 2 comas at transplantation versus 56% (p < 0.001) in those with grade 3 comas; it was 51% versus 81% (p < 0.001) in those transplanted with high risk (ABOincompatible, split, or steatotic) and low-risk grafts, respectively. In a multivariate analysis, steatotic and partial grafts were predictive of poorer patient survival, and ABO incompatibility was predictive of poorer graft survival. ConclusionsOrthotopic liver transplantation is an effective treatment in fulminant hepatitis. Use of high-risk grafts permitted transplantation of 83% of patients, but was responsible for higher mortality.109

Liver transplantation for wilson's disease: A single-center experience

“…The need for early access to OLT in patients with FHF or SHF to prevent the high perioperative morbidity and mortality has been discussed. 35 The male-female ratio in our patient population was 19:26; however, this ratio in our FHF or SHF group was 10:20, which was not statistically significant. This difference has been observed by others, and the question of hormonal factors in the induction of FHF has been raised.…”

Acute liver failure due to antitubercular therapy: Strategy for antitubercular treatment before and after liver transplantation

“…All patients with ALF were managed according to a standardized protocol. 18,19 ALF was defined as a PT level <50% with or without hepatic encephalopathy (HE). 20 Encephalopathy was graded from 1 (least severe) to 4 (most severe).…”

“…21 The criterion for LT was the presence of grade 3-4 HE associated with either a factor V level <20% of normal in patients <30 years of age or a factor V level <30% of normal in patients >30 years of age. 18,22,23 On admission, extracorporeal liver support involving a molecular adsorbent recycling system 24,25 or a bioartificial liver was initiated in 3 patients. [25][26][27] After LT, all patients received immunosuppressive therapy according to the standard practice of our center.…”

Sequential Observation of Liver Cell Regeneration after Massive Hepatic Necrosis in Auxiliary Partial Orthotopic Liver Transplantation

“…Liver cell regeneration after massive hepatic necrosis as a result of fulminant hepatitis has not been pathologically examined in detail because most patients have had a fatal course; even if they had survived, biopsy examination often would have been life threatening because of hemorrhagic diathesis. Recently, however, it has been shown that liver cell regeneration after necrosis can be observed in the native liver after APOLT (2,(5)(6)(7), and there have been a limited number of reports describing regenerative liver cells in fulminant hepatitis in APOLT. In these reports, ductular hepato-cytes were considered to be the putative progenitor cells of hepatocytes (11)(12)(13)(14).…”