Transplantation of complete and split liver grafts for patients with fulminant hepatic failure

Fulminant hepatic failure is associated with considerable mortality under conservative management. The aim of this study was to assess applicability and outcome of liver transplantation using cadaveric and living donated grafts in patients with fulminant hepatic failure. 42 patients presenting with fulminant hepatic failure between 1988 and 1995 were retrospectively analyzed. 37 (88%) met the indication criteria for liver transplantation. 22 patients underwent orthotopic liver transplantation, one patient auxiliary orthotopic liver transplantation. Actual survival rate of these patients is 74% alter a mean follow-up of 23 (3-68) months. 38% (14/37) of the patients with an indication for transplantation did not receive a cadaveric graft due to scarcity of cadaveric organs (n = 9), medical contraindications (n = 3) or spontaneous recuperation (n = 2). Only 21% (3/14) of these patients survived. Due to unavailability of a cadaveric organ four patients, six months to 22 years of age, underwent living related liver transplantation as a last possible treatment option. Three of them died from cerebral herniation. It is concluded that transplantation of a cadaveric graft increased survival rate from 21% to 74% in patients with an indication for liver transplantation. Living related liver transplantation as an individual rescue therapy had no favourable outcome.