Fulminant hepatic failure and liver transplantation: experience of Virgen de la Arrixaca Hospital.
BACKGROUND
For patients with fulminant hepatic failure who show a poor evolution despite medical treatment, liver transplantation is an option, with survival rates of greater than 50%. The ideal time to perform the transplant is controversial, as it must not be done too soon (when the liver disease is still reversible) or too late (when the patient is in an irreversible clinical situation).


METHODS
Retrospective review of the clinical histories of 34 patients admitted to our hospital with a diagnosis of fulminant hepatic failure included 26 who underwent transplantation. The most frequent cause was viral (n=10, 38%); with no etiology established in 11 cases (42%). Thirteen patients had preoperative complications, the most frequent being renal insufficiency. As for degree of AB0/DR compatibility, 13 cases were identical (40%), 17 compatible (51%), and the other three incompatible (9%).


RESULTS
Thirty-three transplants were performed in 26 patients: four were retransplants due to chronic rejection, two for primary graft failure, and one for hyperacute rejection. The overall mortality rate was 46% (12 patients). The most frequent cause of death was infection (50%). The overall actuarial survival rate was 68% at 1 year, 63% at 3 years, and 59% at 5 years. The factors associated with a poor prognosis were renal and respiratory insufficiency, a grade D electroencephalogram, and encephalopathy grades III and IV, the last being the only prognostic factor identified in the multivariate analysis. The prognostic factors for mortality were a grade D electroencephalogram, encephalopathy grades III and IV and respiratory insufficiency, the last being the only prognostic factor identified in the multivariate analysis.


CONCLUSIONS
Good results of transplantation for the management of fulminant hepatic failure depends on optimal selection of transplant candidates, which means identifying them early, reducing the waiting time, and excluding factors associated with a poor prognosis.
Fernández
J A
JA
Servicio de Cirugía I, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. jumanjico@yahoo.com
Robles
R
R
Marín
C
C
Hernández
Q
Q
Sánchez Bueno
F
F
Ramírez
P
P
Rodríguez
J M
JM
Luján
J A
JA
Acosta
F
F
Parrilla
P
P
D000704:Analysis of Variance; D002423:Cause of Death; D005500:Follow-Up Studies; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000502:physiology*; D012189:Retrospective Studies; D013030:Spain; D016019:Survival Analysis; D013997:Time Factors