Management of fulminant hepatic failure at Queen Mary Hospital

To evaluate the strategy of the management of patients with fulminant hepatic failure at Queen Mary Hospital.

In the period 1994 through 1996, 30 patients with fulminant hepatic failure were managed by active supportive treatment in the Intensive Care Unit in preparation for liver transplantation. Liver transplantation was performed in 14 patients (aged 17-47), 3 of whom received liver grafts from brain-stem dead donors and 11 received live-related grafts from family members. The median duration from admission to liver transplantation was 3 days (range: 1-6 days).

Thirteen patients (93%) survived the liver transplantation and are well after a median period of follow-up of 7 months. The only mortality was in a patient with pre-exiting renal transplantation and hepatitis B infection, who died from intra-abdominal candidiasis.

The strategy of active supportive treatment and early liver transplantation using live-related liver graft is probably the key to the success of the management of fulminant hepatic failure in our series.