[Fulminant and subfulminant hepatitis treated by orthotopic transplantation of the liver. Apropos of 10 cases].
In the period between 15/12/1987 and 15/08/1989, ten patients with either fulminating or subfulminating hepatitis have been treated by orthotopic liver transplantation (O.L.T.). Six patients are doing well in the post-operative period with a mean follow-up of 12 months (7-23 months). No evidence of neurological sequelae has been observed and recurrence of HB virus infection was absent from the three cases who survived hepatitis B transplantation. Four out these ten patients died after initial successful O.L.T... One patient succumbed 7 days after O.L.T. from sepsis or early super-acute rejection, the second 21 days after O.L.T. from neuromeningeal listeria, the third 43 days post O.L.T. from acute rejection, while the fourth developed cytomegalovirus pneumonia and died 61 days after O.L.T. Orthotopic liver transplantation has become the treatment of fulminating hepatitis. It is an emergency which is usually accompanied by successive difficulties in decision making: indication criteria, then acceptance or refusal of ABO incompatible grafts (5/10) and of suboptimal donors. Orthotopic liver transplantation for fulminating hepatitis is technically easy to perform, but usually requires the use of extra-corporal veno-venous circulation. Accompanying intensive medical care is essential and usually includes one or multiple plasmaphereses to correct existing coagulopathy without any fluid or sodium overload to the circulation.
Pouyet
M
M
Ducerf
C
C
Gaussorgues
P
P
Salord
F
F
Sirodot
M
M
Caillon
P
P
Dubois
J M
JM
Rivoire
M
M
Baulieux
J
J
Bouletreau
P
P
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000601:surgery; D006509:Hepatitis B / Q000150:complications / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
Hépatites fulminantes et sub-fulminantes traitées par transplantation orthotopique du foie. A propos de dix cas.