COURSE OF ACUTE LIVER-FAILURE AND INDICAT IONS FOR LIVER-TRANSPLANTATION

Objective: To analyse the course of acute liver failure and the indica tions for liver transplantation. Patients and methods: In 16 patients who developed acute liver failure between July 1992 and July 1997 the indications for liver transplantation and total survival time were ana lysed retrospectively. Results: Intensive medical care (ventilation, d ialysis) was necessary in 60% of the patients to bridge organ failure until liver transplantation. In 14 patients liver transplantation was indicated. Eleven of the patients, with a minimal Quick value of less than 10%, presented with the prognostically poorest London criteria. I n two patients the combination of three additional criteria of the Lon don classification led to liver transplantation being indicated. In on e patient with Wilson's disease the transplantation was undertaken des pite good clotting factor synthesis, because an encephalopathy occurre d. In two patients liver transplantation was not undertaken even thoug h indicated, in one because liver functions improved, in the other bec ause necrotizing pancreatitis had occurred. In another patient, who ha d been poisoned by eating the mushroom Amanita phalloides, the attempt ed transplantation was cut short, because intestinal necrosis had deve loped, and the patient died during the operation. Nine of the eleven p atients who had a transplantation and three of the four treated conser vatively survived. Conclusion: The 60-day survival rate in this series , achieved in a recently established transplantation programme, is hig h (12 of 16; 75%), being comparable to those in larger transplantation centres.