Bridge therapy to liver transplantation in fulminant hepatic failure.
The management of patients with fulminant hepatic failure is a major clinical endeavor. Early intensive care at an institution able to perform liver transplantation is essential. It is recognized that therapy focused solely on attempts at preventing/reversing increased intracranial pressure, and the treatment of other failing organs as they occur falls well short of ideal. This review covers the non-biological and biological techniques utilized in efforts to support liver function. The goal is to foster recovery, or to buy enough time for successful liver transplantation. Prospective, controlled trials are beginning to acknowledge subgroups of fulminant hepatic failure and properly randomize therapy. Our understanding of the essential elements of liver support is improving, but no single device has yet proved indispensable.
Merritt
W T
WT
Department of Anesthesiology/CCM, Johns Hopkins Hospital, Baltimore, Maryland, USA. wmerritt@jhmi.edu