[Fulminant hepatic failure and liver transplantation]

Fulminant hepatic failure (FHF) is defined as the onset of grade II hepatic encephalopathy within 8 weeks after the onset of jaundice in patients whose prothrombin time is less than 40%. There are an estimated 3,700 cases of FHF in Japan. There are no specific therapies for FHF, however, liver transplantation is recommended for situations in which spontaneous recovery appears unlikely. The 1-year graft survival after liver transplantation for FHF is 65 to 80%. At present, orthotopic liver transplantation has become an accepted procedure for FHF. The advantages of auxiliary transplantation in FHF are the temporary requirement for immunosuppression drugs until the host liver recovers and the relative ease of surgery. Two types of auxiliary liver support are possible: heterotopic (APL) and orthotopic (APOLT). APLT is technically easier but suffers from competition between the graft and native liver for portal blood supply, problems of venous congestion and potential lack of space. However, APOLT has a more secure portal blood supply than APLT. Several technical problems with auxiliary transplantation need further evaluation.