title: Fulminant hepatic failure and the potential role of liver dialysis.
abstract: Fulminant hepatic failure (FHF) carries a high mortality. We aimed to review the prognostic factors and explore the potential role of Liver Dialysis (LD). Fifty-two patients were reviewed. The etiologies were acetaminophen toxicity (33%), viral hepatitis (18%), autoimmune (10%), idiosyncratic drug reactions (8%), others (6%) and undetermined (25%). Patients with acetaminophen had a significantly higher survival compared to the non-acetaminophen group (p=0.04). Patients with grade 3 encephalopathy had a mortality of 68%, among 5 patients with grade IV encephalopathy, 2 survived and both had had treatment with LD. Chi-square with Fisher's exact test was used for statistical analysis. Our study confirmed that the diagnosis of non-acetaminophen induced FHF and reduced initial serum factor V level are associated with fatal outcome. Timely OLT significantly improved the survival. The role of LD in hepatic regeneration or as a bridge to OLT needs to be further studied with prospective control trials.
authors.affiliation: Division of Liver Transplantation, Nazih Zuhdi Transplantation Institute, Integris Baptist Medical Center, Oklahoma City, OK, USA.
authors.forename: M
authors.initials: M
authors.lastname: Akdogan
authors.forename: M
authors.initials: M
authors.lastname: Aladag
authors.forename: S
authors.initials: S
authors.lastname: Rashwan
authors.forename: S
authors.initials: S
authors.lastname: Shrago
authors.forename: E
authors.initials: E
authors.lastname: Warner
authors.forename: A
authors.initials: A
authors.lastname: Sebastian
authors.forename: H
authors.initials: H
authors.lastname: Wright
authors.forename: B
authors.initials: B
authors.lastname: Nour
authors.forename: A
authors.initials: A
authors.lastname: Gurakar
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008111:Liver Function Tests; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome