USE OF EXTRACORPOREAL LIVER ASSIST DEVICE AND AUXILIARY LIVER-TRANSPLANTATION IN FULMINANT HEPATIC-FAILURE

The case history of a 14-year-old boy with fulminant hepatic failure s econdary to non-A, non-B hepatitis who fulfilled selection criteria fo r orthotopic liver transplantation is described. Two forms of liver su pport were used (extracorporeal liver assist device and an auxiliary p artial orthotopic liver transplantation) to provide additional time to allow spontaneous recovery to occur. During the 66 h of extracorporea l haemoperfusion through the device, haemodynamic stability was mainta ined along with improvements in serum bilirubin (555 to 381 mu mol/l), and international normalized ratio (INR) (3.7 to 2.9). Deterioration in these parameters was observed following cessation of treatment and 10 h later, after a donor liver had become available, an auxiliary tra nsplant was performed. Clinical recovery, though initially slow, was e ventually complete, with histopathological and scintigraphic evidence of full liver regeneration at 3 months. Withdrawal of his immunosuppre ssive drugs began at 6 months and was complete by 14 months after auxi liary transplantation. He has since remained well with normal liver fu nction tests. Temporary liver support may provide additional time for spontaneous recovery of the native liver to occur in selected cases of fulminant hepatic failure, even when criteria are fulfilled for ortho topic liver grafting.