Orthotopic liver transplantation in fulminant and subfulminant hepatitis. The Paul Brousse experience.
OBJECTIVE
The authors report on the experience of orthotopic liver transplantation in fulminant hepatitis at Paul Brousse Hospital.


BACKGROUND
Liver 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.


METHODS
Transplantation 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.


RESULTS
Among 139 patients who met the aforementioned criteria for transplantation, 1 recovered, 22 died before transplantation, and 116 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 (ABO-incompatible, 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.


CONCLUSIONS
Orthotopic 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.
Bismuth
H
H
Hepato-Biliary Center, Assistance Publique-Hôpitaux de Paris, France.
Samuel
D
D
Castaing
D
D
Adam
R
R
Saliba
F
F
Johann
M
M
Azoulay
D
D
Ducot
B
B
Chiche
L
L
D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001929:Brain Edema / Q000517:prevention & control; D002648:Child; D005165:Factor V / Q000032:analysis; D005260:Female; D005544:Forecasting; D006085:Graft Survival; D006501:Hepatic Encephalopathy / Q000097:blood / Q000601:surgery*; D006505:Hepatitis / Q000097:blood / Q000601:surgery*; D006648:Histocompatibility; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000145:classification / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009460:Neurologic Examination; D010297:Paris / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D005165:Factor V