Results of liver transplantation in fulminant hepatic failure

Liver transplantation has dramatically changed the management of patients with fulminant hepatic failure and subacute hepatic failure. A wide range of survival rates (55% to 90%) reported from different centers performing liver transplantation for fulminant hepatic failure reflects variations in patient selection and the centers' experience. Results of transplantation appear to be improving, with survival rates approaching 80% at 1 year in some series. The improved results are attributed to vigorous perioperative management, using intracranial pressure monitoring and continuous arteriovenous hemofiltration when required, early listing of patients with organ-sharing network, and exclusion of patients who are unlikely to recover neurologically after successful transplantation. Use of piggyback hepatectomy to minimize hemodynamic alterations during surgery has also contributed to better results in critically ill patients. Patients with acetaminophen toxicity have a more favorable outcome than those with viral hepatitis or non-acetaminophen drug hepatotoxicity. Because of limited availability of cadaveric organs, emergency living-related liver transplantation, use of ABO incompatible and marginal livers need consideration. Auxiliary liver transplantation is desirable for those who have a chance of spontaneous recovery, thus obviating life-long immunosuppression after recovery of the native liver.