Liver transplantation in fulminant hepatic failure: experience with 40 adult patients over a 17-year period.
BACKGROUND
To evaluate the influence of pretransplantation recipient and donor prognostic factors on graft-patient survival.


METHODS
Between April 1986 and June 2003, 40 liver transplantation (LT) procedures to treat fulminant hepatic failure were performed (5.7%). Twenty-one pre-LT recipient and donor variables were retrospectively considered for analysis.


RESULTS
The indications for LT were hyperacute (62.5%), acute (35%), and subacute hepatic failure (2.5%). Glasgow Coma Scale scores ranged from <5 in 22 patients to > or =5 in 18 patients. The causes were hepatitis B (n = 21), unknown (n = 10), Amanita phalloides (n = 5), and other (n = 4). The 1-year graft and patient survival rates were 48.3% and 61.3%, respectively. Perioperative and late mortality was 27.5% and 22.5%. The only variable statistically significant for graft survival was waiting list time for LT <48 hours (P = .05).


CONCLUSIONS
Liver transplantation is the best treatment for fulminant hepatic failure, with a 1-year patient survival rate of 61.3%. The short waiting list time has an important role in outcome.
Montalti
R
R
Department of Surgery, ICU and Transplantation, University of Bologna, S. Orsola Hospital, Bologna, Italy. robertomontalti@yahoo.it
Nardo
B
B
Beltempo
P
P
Bertelli
R
R
Puviani
L
L
Cavallari
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006085:Graft Survival; D006801:Humans; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome