LIVER-TRANSPLANTATION FOR FULMINANT HEPATIC-FAILURE - IMPORTANCE OF RENAL-FAILURE

One hundred eighty-one consecutive patients with fulminant hepatic fai lure (FHF) presenting in a 2-year period were reviewed. In this cohort we examined the impact of pretransplant renal failure on mortality an d morbidity following orthotopic liver transplantation (OLTx). Twenty- seven patients (18 female, 9 male) with a median age of 43.5 years (ra nge 19-65 years) underwent OLTx. FHF was due to idiosyncratic drug rea ction (n = 4), paracetamol overdose (n = 3), seronegative hepatitis (n = 17), hepatitis B (n = 1), veno-occlusive disease (n = 1), and Wilso n's disease (n = 1). Renal failure was present in 14 patients, 7 of wh om died (whereas there was 100 % survival in patients without renal fa ilure). Pretransplant renal failure was associated with prolonged mech anical ventilation (13 days vs 6 days, P = 0.05), prolonged intensive care stay (17 days vs 8 days, P = 0.01) and prolonged hospital stay (2 7 vs 21 days, P = NS). Pretransplant re nal failure did not predict re nal dysfunction at 1 year after OLTx. We conclude that the survival of patients transplanted for FHF is inferior to that of patients transpl anted for chronic liver disease (67 % vs 88 % 1-year survival in Birmi ngham). For patients with FHF undergoing transplantation; pretransplan t renal failure strongly predicts poor outcome with significantly grea ter consumption of resources.