Living-related liver transplantation for patients with fulminant and subfulminant hepatic failure

The prognosis for patients with fulminant (FHF) or subfulminant hepatic fai lure (SFHF) has improved since the introduction of liver transplantation. H owever, the death rate of patients awaiting liver transplantation is high, possibly because of the difficulty in obtaining grafts in a timely manner, given the relative shortage of cadaveric donors. Between June 1990 and June 1999, 106 patients underwent living-related liver transplantation (LRLT) a t Shinshu University Hospital. Among them, 8 patients had FHF and 6 had SFH F; these 14 patients are the subjects of this report. The graft volumes (GV ) ranged from 231 mt to 625 mt, corresponding to 35% to 105% of the recipie nts' standard liver volume (SLV). The postoperative courses of all donors w ere uneventful. Following liver transplantation, all grafts functioned favo rably, with normalization of serum total bilirubin within 3 to 5 days and n ormalization of coagulation profiles within 4 to 7 days. Thirteen of the 14 recipients are still alive. The actuarial 6-month, 1-year, and 5-year surv ival rates were 100%, 90%, and 90%, respectively. In the present study, whe n the ratio of the GV to the recipient's SLV was more than 35%, the graft w as able to support the patient's metabolic demand after liver transplantati on for FHF or SFHF Because of the urgent nature of liver transplantation in this clinical condition, concerns over informed consent may be even greate r than for elective LRLT. Nevertheless, the high success rate and low donor risk may justify this option for pediatric patients, as well as for a limi ted population of adult patients suffering from FHF or SFHF.