title: Liver transplantation for fulminant hepatic failure: importance of renal failure.
abstract: One hundred eighty-one consecutive patients with fulminant hepatic failure (FHF) presenting in a 2-year period were reviewed. In this cohort we examined the impact of pretransplant renal failure on mortality and morbidity following orthotopic liver transplantation (OLTx). Twenty-seven patients (18 female, 9 male) with a median age of 43.5 years (range 19-65 years) underwent OLTx. FHF was due to idiosyncratic drug reaction (n = 4), paracetamol overdose (n = 3), seronegative hepatitis (n = 17), hepatitis B (n = 1), veno-occlusive disease (n = 1), and Wilson's disease (n = 1). Renal failure was present in 14 patients, 7 of whom died (whereas there was 100% survival in patients without renal failure). Pretransplant renal failure was associated with prolonged mechanical ventilation (13 days vs 6 days, P = 0.05), prolonged intensive care stay (17 days vs 8 days, P = 0.01) and prolonged hospital stay (27 vs 21 days, P = NS). Pretransplant renal failure did not predict renal dysfunction at 1 year after OLTx. We conclude that the survival of patients transplanted for FHF is inferior to that of patients transplanted for chronic liver disease (67% vs 88% 1-year survival in Birmingham). For patients with FHF undergoing transplantation, pretransplant renal failure strongly predicts poor outcome with significantly greater consumption of resources.
authors.affiliation: Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mendoza
authors.forename: F
authors.initials: F
authors.lastname: Fernandez
authors.forename: D J
authors.initials: DJ
authors.lastname: Mutimer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051437:Renal Insufficiency / Q000150:complications / Q000503:physiopathology*