Liver Transplantation for Fulminant Hepatic Failure

Abstract

Fulminant hepatic failure (FHF) is the clinical syndrome associated with acute massive necrosis of the liver that has been functioning normally before the onset of illness. It is characterized by increasing jaundice, decrease in the size of the liver, fetor hepaticus, coagulopathy, renal failure, hepatic encephalopathy, and eventual death. The mortality rate for FHF when associated with grade IV coma is 80 to 95%.1,2 The symptoms of hepatic failure (especially encephalopathy) develop within eight weeks from the onset of illness. Various modalities of medical treatment have been applied for FHF, but none of these has had a significant impact on the lethal prognosis.3–5 With the significant improvement in the results of liver transplantation over the past several years,6,7 liver replacement has become a practical therapeutic option for advanced FHF.8,9 We report here our experience with liver transplantation for FHF in 42 patients under the cyclosporine (CsA)/steroid immunosuppressive therapy.