LIVER-TRANSPLANTATION FOR ACUTE HEPATIC-FAILURE

Acute hepatic failure is characterized by jaundice and hepatic encepha lopathy within eight weeks after the onset of disease. Although acute hepatic failure is a rare occurrence, its rapid progression and high m ortality (50 to 90%, depending on the etiology of disease) necessitate immediate intervention. In the absence of causal therapy, orthotopic liver transplantation is currently the only definitive and effective m eans of treating acute hepatic failure In Europe, acute hepatic failur e accounts for 11% of all liver transplantations. At the University de partment of tranplantation surgery in Vienna a total of 27 patients wi th acute hepatic failure underwent 31 liver transplantations in the la st 10 years (1.1.1987 to 31.12.1996). Twenty (74%) of the 27 patients survived the acute event and were discharged from hospital in good gen eral condition after a median postoperative stay of 25 days (range 14- 81 days). Seven patients (26%) died between the first and 34th postope rative day (median 26 days) in the intensive care unit, although all p otential modern options of intensive care and surgery were used. The c auses of death were irreversible cerebral edema (n = 3), multiple orga n failure due to bacterial sepsis (n = 3) and uncontrollable haemolysi s (n = 1). With a 3-year graft survival rate of 70% the 3-year patient survival rate was 74%. A retrospective analysis of our patients revea led that the postoperative graft function and the incidence of re-tran splantation were significant prognostic factors (p < 0.05) for surviva l folllowing orthotopic liver transplantation for acute hepatic failur e. In the abscence of further prognosticlly relevant preoperative indi ces and in consideration of the potentially fulminant progression of d isease, we strongly recommend that any patient, in whom acute hepatic failure is suspected, is immediately transferred to a specialized cent er with experience both in the conservative treatment of acute hepatic failure and emergency river transplantation.