LIVER-TRANSPLANTATION FOR FULMINANT HEPATIC-FAILURE IN THE UNITED-STATES - OCTOBER 1987 THROUGH DECEMBER 1991

Background Early mortality and retransplantation rates following liver transplantation for fulminant hepatic failure (FHF) are high. We inve stigated possible reasons for these findings. Methods. Data were obtai ned from the liver transplantation database of the United Network for Organ Sharing (UNOS) Scientific Registry. Recipient information was li mited to waiting time; diagnosis; demographic, laboratory and serologi c data; and six UNOS functional status codes. Donor information includ ed demographic characteristics, cause of death, ABO blood type, and se rology test results. Comparisons between FHF and non-FHF were carried out for children and adults separately. The influence of an FHF diagno sis on 1-year patient and graft survival was examined using the Cox pr oportinal hazard model. The same model was used to determine independe nt predictors of outcome following transplantation for FHF. Results. T he majority of FHF recipients were on pretransplant life support, had much shorter waiting times, and were less well matched for ABO blood t ype (especially the children) than their non-FHF counterparts. Althoug h 1-year survival and graft survival were significantly lower, the sig nificance of these differences was eliminated when the initial recipie nt, donor and matching characteristics between the two groups were con trolled in the analysis. For FHF recipients, ABO mismatch and abnormal kidney function were the strongest independent predictors of adverse outcome. Conclusions. The results of this study provide circumstantial evidence that patients with FHF derive as much benefit from liver tra nsplantation as patients with other diagnoses of comparable severity.