RECOVERY DESPITE IMPAIRED CEREBRAL PERFUSION IN FULMINANT HEPATIC-FAILURE

We report 4 patients with fulminant hepatic failure who developed prol onged intracranial hypertension (> 35 mm Hg for 24-38 h) that was refr actpty to standard therapy and associated with impaired cerebral perfu sion pressure (< 50 mm Hg for 2-72 h). All survived with complete neur ological recovery. Refractory elevation of intracranial pressure and r educed cerebral perfusion pressure are generally thought to contra-ind icate liver transplantation in hepatic failure and are indications to withdraw support. Our observations challenge this concept.