Liver transplantation for fulminant hepatic failure: experience with more than 200 patients over a 17-year period.
OBJECTIVE
To analyze outcomes after liver transplantation (LT) in patients with fulminant hepatic failure (FHF) with emphasis on pretransplant variables that can potentially help predict posttransplant outcome.


BACKGROUND
FHF is a formidable clinical problem associated with a high mortality rate. While LT is the treatment of choice for irreversible FHF, few investigations have examined pretransplant variables that can potentially predict outcome after LT.


METHODS
A retrospective review was undertaken of all patients undergoing LT for FHF at a single transplant center. The median follow-up was 41 months. Thirty-five variables were analyzed by univariate and multivariate analysis to determine their impact on patient and graft survival.


RESULTS
Two hundred four patients (60% female, median age 20.2 years) required urgent LT for FHF. Before LT, the majority of patients were comatose (76%), on hemodialysis (16%), and ICU-bound. The 1- and 5-year survival rates were 73% and 67% (patient) and 63% and 57% (graft). The primary cause of patient death was sepsis, and the primary cause of graft failure was primary graft nonfunction. Univariate analysis of pre-LT variables revealed that 19 variables predicted survival. From these results, multivariate analysis determined that the serum creatinine was the single most important prognosticator of patient survival.


CONCLUSIONS
This study, representing one of the largest published series on LT for FHF, demonstrates a long-term survival of nearly 70% and develops a clinically applicable and readily measurable set of pretransplant factors that determine posttransplant outcome.
Farmer
Douglas G
DG
Department of Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, USA. dgfarmer@mednet.ucla.edu
Anselmo
Dean M
DM
Ghobrial
R Mark
RM
Yersiz
Hasan
H
McDiarmid
Suzanne V
SV
Cao
Carlos
C
Weaver
Michael
M
Figueroa
Jesus
J
Khan
Khurram
K
Vargas
Jorge
J
Saab
Sammy
S
Han
Steven
S
Durazo
Francisco
F
Goldstein
Leonard
L
Holt
Curtis
C
Busuttil
Ronald W
RW
D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000097:blood* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D003404:Creatinine; D001663:Bilirubin