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Acute and subacute fulminant hepatic failure: the role of liver transplantation

1991; Wiley; Volume: 154; Issue: 11 Linguagem: Inglês

10.5694/j.1326-5377.1991.tb121308.x

1326-5377

A. G. R. Sheil, Geoffrey W. McCaughan, H Isai, Felicity Hawker, John F. Thompson, Stuart Dorney,

Organ Transplantation Techniques and Outcomes

Medical Journal of AustraliaVolume 154, Issue 11 p. 724-728 Original Article Acute and subacute fulminant hepatic failure: the role of liver transplantation A G Ross Sheil MS, FRCS, FRACS, FACS, A G Ross Sheil MS, FRCS, FRACS, FACS Chairman and Director, Professor of Surgery Australian National Liver Transplantation Unit, E.11, Royal Prince Alfred Hospital, Camperdown, NSW, 2050Search for more papers by this authorGeoffrey W McCaughan MB BS, PhD, FRACP, Geoffrey W McCaughan MB BS, PhD, FRACP Physician-in-Charge, Transplantation Hepatology Australian National Liver Transplantation Unit, E.11, Royal Prince Alfred Hospital, Camperdown, NSW, 2050Search for more papers by this authorHideya Isai MD, Hideya Isai MD Fellow in Transplantation Surgery Australian National Liver Transplantation Unit, E.11, Royal Prince Alfred Hospital, Camperdown, NSW, 2050Search for more papers by this authorFelicity Hawker BMedSci, MB BS, FFARCS, FFARACS, Felicity Hawker BMedSci, MB BS, FFARCS, FFARACS Co-Director, Intensive Care Unit Australian National Liver Transplantation Unit, E.11, Royal Prince Alfred Hospital, Camperdown, NSW, 2050Search for more papers by this authorJohn F Thompson MB BS, FRACS, FACS, John F Thompson MB BS, FRACS, FACS Surgeon, Deputy Director Australian National Liver Transplantation Unit, E.11, Royal Prince Alfred Hospital, Camperdown, NSW, 2050Search for more papers by this authorStuart F A Dorney MB BS, FRACP, Stuart F A Dorney MB BS, FRACP Physician-in-Charge, Transplantation Hepatology Australian National Liver Transplantation Unit, Children's Hospital, Camperdown, NSW, 2050Search for more papers by this author A G Ross Sheil MS, FRCS, FRACS, FACS, A G Ross Sheil MS, FRCS, FRACS, FACS Chairman and Director, Professor of Surgery Australian National Liver Transplantation Unit, E.11, Royal Prince Alfred Hospital, Camperdown, NSW, 2050Search for more papers by this authorGeoffrey W McCaughan MB BS, PhD, FRACP, Geoffrey W McCaughan MB BS, PhD, FRACP Physician-in-Charge, Transplantation Hepatology Australian National Liver Transplantation Unit, E.11, Royal Prince Alfred Hospital, Camperdown, NSW, 2050Search for more papers by this authorHideya Isai MD, Hideya Isai MD Fellow in Transplantation Surgery Australian National Liver Transplantation Unit, E.11, Royal Prince Alfred Hospital, Camperdown, NSW, 2050Search for more papers by this authorFelicity Hawker BMedSci, MB BS, FFARCS, FFARACS, Felicity Hawker BMedSci, MB BS, FFARCS, FFARACS Co-Director, Intensive Care Unit Australian National Liver Transplantation Unit, E.11, Royal Prince Alfred Hospital, Camperdown, NSW, 2050Search for more papers by this authorJohn F Thompson MB BS, FRACS, FACS, John F Thompson MB BS, FRACS, FACS Surgeon, Deputy Director Australian National Liver Transplantation Unit, E.11, Royal Prince Alfred Hospital, Camperdown, NSW, 2050Search for more papers by this authorStuart F A Dorney MB BS, FRACP, Stuart F A Dorney MB BS, FRACP Physician-in-Charge, Transplantation Hepatology Australian National Liver Transplantation Unit, Children's Hospital, Camperdown, NSW, 2050Search for more papers by this author First published: 01 June 1991 https://doi.org/10.5694/j.1326-5377.1991.tb121308.xCitations: 22AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Objectives To report the experience of the Australian National Liver Transplant Unit with patients with fulminant hepatic failure and to describe the role of liver transplantation. Patients: Twenty-seven patients presented with acute or subacute fulminant hepatic failure during the period from January, 1986, to March, 1990. Twenty-two had acute arid five had subacute fulminant hepatic failure. The causes were hepatitis B in 10 patients, presumed non-A, non-B {NANB) hepatitis in eight patients, drug-induced hepatic damage in five patients, and Wilson's disease in four patients. There were 13 males and 14 females. Ages were 2–43 years (mean, 23). Twenty patients (74%) were in grade IV encephalopathy on presentation. Results Six patients (22%) began to improve soon after admission and went on to full recovery. Spontaneous recovery was more frequent in patients with drug-induced hepatic damage (four patients [80%]) and was less frequent in those with hepatitis B (one patient [10% and NANB hepatitis (one patient [12%. The other 21 patients (78%) were considered for orthotopic liver transplantation. Eight (30%) were judged to be unsuitable and went. on to early death. Thirteen (48%).were suitable for transplantation. Of these five (19%) died before a liver donor became available and eight (30%) received liver grafts and went. on to full recovery. Overall, 14 patients (52%) survived and 13 (48%) died. Patients with Wilson's disease (four [100% were most suitable for orthotopic liver transptantatlon whereas eight (44%) of those with hepatitis B or NANB hepatitis were unsuitable. Of the eight patients receiving liver grafts one. had hepatitis B, three had NANB hepatitis and four had Wilson's disease. Five were in grade IV encephalopathy at the time of operation. The mean waiting time for transplantation was 6.4 days. Five patients received ABO blood group compatible grafts and three received ABO incompatible grafts. Of the latter group, two subsequently required secondary orthotopic liver transplantation with ABO compatible grafts. All eight patients who received transplants are alive and well 3–24 months after the operation. No patient has any neurological sequelae. Conclusions Orthotopic liver transplantation is a preferred option. for patients with fulminant hepatic failure whose condition is not responding to conservative management. ABO incompatible livers transplanted in emergency circumstances may prove lifesaving either by functioning successfully or by providing time during which ABO compatible grafts become available. Despite the availability of liver transplantation, many patients with fulminant hepatic failure in Australia still die, some before hepatic transplantation can be undertaken. Early referral of patients with fulminant hepatic failure to established centres with liver transplantation programmes is required. Citing Literature Volume154, Issue11June 1991Pages 724-728 RelatedInformation