TRANSPLANTATION OF COMPLETE AND SPLIT LIVER GRAFTS FOR PATIENTS WITH FULMINANT HEPATIC-FAILURE

Fulminant hepatic failure is associated with considerable mortality un der conservative management. The aim of this study was to assess appli cability and outcome of liver transplantation using cadaveric and livi ng donated grafts in patients with fulminant hepatic failure. 42 patie nts presenting with fulminant hepatic failure between 1988 and 1995 we re retrospectively analyzed. 37 (88%) met the indication criteria for liver transplantation. 22 patients underwent orthotopic liver transpla ntation, one patient auxiliary orthotopic liver transplantation. Actua l survival rate of these patients is 74% after a mean follow-up of 23 (3-68) months, 38% (14/37) of the patients with an indication for tran splantation did not receive a cadaveric graft due to scarcity of cadav eric 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 las t possible treat ment option. Three of them died from cerebral herniat ion. It is concluded that transplantation of a cadaveric graft increas ed survival rate from 21% to 74% in patients with an indication for li ver transplantation. Living related liver transplantation as an indivi dual rescue therapy had no favourable outcome.