Fulminant hepatic failure: a Portuguese experience

Area of Science:

• Hepatology
• Intensive Care Medicine
• Transplantation Surgery

Background:

• Fulminant hepatic failure (FHF) is a rare, life-threatening condition.
• This study presents the first report on FHF from a Portuguese population, offering insights into Southwestern European cases.
• Previous FHF studies have been reported by individual centers or multicenter collaborations.

Purpose of the Study:

• To document the clinical experience with FHF at a Portuguese Hepatogastroenterological Intensive Care Unit.
• To analyze the causes, evolution, and management of FHF in this specific population.
• To evaluate the application of hepatic transplantation (HT) criteria and outcomes.

Main Methods:

• Retrospective analysis of 61 consecutive FHF cases admitted between February 1992 and October 2006.
• Utilized established definitions and classifications for FHF (Trey and Davidson, O'Grady et al.).
• Applied specific criteria and contraindications for hepatic transplantation (HT) (Bernuau et al., Muñoz).

Main Results:

• The median age of patients was 37 years, with 57% being female.
• The most common causes of FHF were indeterminate (26%), viral (23%), and drug-induced (23%).
• 51% of cases presented with hyperacute evolution; 54% underwent HT with an applicability rate of 62% based on established criteria.

Conclusions:

• Viral and drug-induced agents account for nearly half of FHF cases, often with hyperacute presentation.
• The HT rate was 54%, with a 62% applicability rate, suggesting effective use of criteria.
• An overall 1-year survival rate of 69% indicates the adequacy of the HT criteria employed.