ORTHOTOPIC LIVER-TRANSPLANTATION IN FULMINANT AND SUBFULMINANT HEPATITIS - THE PAUL-BROUSSE EXPERIENCE

Objective The authors report on the experience of orthotopic liver tra nsplantation in fulminant hepatitis at Paul Brousse Hospital. Summary Background Data Liver transplantation is a breakthrough in the treatme nt of patients with fulminant hepatitis. However, the indications the timing for transplantation, the type of transplantation, and the use o f ABO incompatible grafts in this setting still are debated. Methods T ransplantation was indicated in patients with confusion or coma and fa ctor V less than 20%, younger than 30 years of age, and confusion or c oma and factor V less than 30% older than 30 years of age. Results Amo ng 139 patients who met the aforementioned criteria for transplantatio n, 1 recovered, 22 died before transplantation, and 116 underwent tran splants with a 1-year survival of 68%. Survival was 83% in patients wi th grade 1 and 2 comas at transplantation versus 56% (p < 0.001) in th ose with grade 3 comas; it was 51% Versus 81% (p < 0.001) in those tra nsplanted with high risk (ABO-incompatible, split, or steatotic) and l ow-risk grafts, respectively. In a multivariate analysis, steatotic an d partial grafts were predictive of poorer patient survival, and ABO i ncompatibility was predictive of poorer graft survival. Conclusions Or thotopic liver transplantation is an effective treatment in fulminant hepatitis. Use of high-risk grafts permitted transplantation of 83% of patients, but was responsible for higher mortality.