title: The importance of orthotopic liver transplantation in acute hepatic failure.
abstract: Selection of patients with acute hepatic failure for liver transplantation remains difficult, and there is no definite proof of a survival effect. We therefore did a retrospective study in 75 consecutive patients referred over a 12-year period. In two-thirds we identified a cause, mostly viruses or drugs. Patients were grouped by the Clichy and King's College criteria. In 20 there was no indication for transplantation. Of the 5 with autoimmune hepatitis, 3 died, significantly differing from the other 15 ( P = 0.009). The remaining 55 met our criteria, except 1. All 9 patients with absolute contraindications died. Of the 46 enlisted, 7 died without transplantation. One-year survival after transplantation was 69%, compared with 58% by "intention to treat." For patients enlisted, transplantation reduced mortality by 78% ( P = 0.069). The Clichy and King's College criteria reliably predict survival without transplantation, except in autoimmune hepatitis. Our study strongly suggests that transplantation improves survival.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: de Rave
authors.forename: Hugo W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: Joke
authors.initials: J
authors.lastname: van der Linden
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Man
authors.forename: Bart
authors.initials: B
authors.lastname: van der Berg
authors.forename: Wim C J
authors.initials: WC
authors.lastname: Hop
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Zondervan
authors.forename: Herold J
authors.initials: HJ
authors.lastname: Metselaar
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis