ACUTE HEPATIC-FAILURE - UNIVERSITY-OF-TORONTO EXPERIENCE

Fulminant hepatic failure (FHF) is a serious disorder of the liver tha t is associated with a mortality of 80 to 90%. Admission of patients t o specialized liver intensive care units has resulted in an improvemen t of survival from 10 to 30%. To date, however, no specific medical th erapy has proven to be effective, and liver transplantation is the mai n form of therapy for these patients. Previously, the author demonstra ted that prostaglandins could alter the course of FHF in an experiment al animal model caused by the coronavirus, murine hepatitis virus stra in 3. Furthermore, in an uncontrolled trial in patients with this diso rder, overall survival was 71% in patients treated with intravenous pr ostaglandins. Based upon these initial results, a prospective randomiz ed controlled trial of intravenous prostaglandin El compared with plac ebo was performed in 41 patients. The overall results showed no improv ement in survival of the prostaglandin-treated patients (40%) compared with the controls who were treated with placebo (38%). However, in th e patients with FHF caused by acetaminophen, survival was higher in th e prostaglandin-treated group (54.5%) compared with the placebo-treate d patients (37.5%). Furthermore, if treatment with prostaglandin E1 wa s initiated within 10 days of first symptoms, survival was 73%, compar ed with 16% survival if treatment was delayed for more than four days. These results suggest a potential role for prostaglandins in the earl y management of patients with FHF, especially due to acetaminophen tox icity.