Liver transplantation in 48 patients with fulminant hepatic failure

Fulminant hepatic failure (FHF) is the most dramatic hepatic disease and is associated with high mortality. Urgent liver transplantation (LT) is the treatment of choice for these patients. From January 2002 to November 2008, 86 patients presented to the hospital with FHF. All patients met the King's College criteria at the time of listing for urgent LT. Drug hepatotoxicity was the most common etiology, affecting 37% of the patients. Methyldopa was the most frequent agent. Thirty-five percent of the patients had cryptogenic FHF, and 14% due to acute hepatitis B virus infection. From 86 patients with FHF, 48 were submitted to LT (36 women and 12 men). During this period there were 181 patients submitted to nonurgent LT. The mean time interval between listing and LT was 2.2 days. MELD scores ranged between 26 and 61 by the time of LT (mean, 41). Patients' median age was 37 years (range, 16 to 70). According to the Briceno score, 75% of hepatic grafts were retrieved from extended criteria donors. Donors were 40 years old or more in 54% of the cases (mean age of 41 years). The 1-year patient actuarial survival rate of transplanted patients with FHF was 57.1% and the 3-year actuarial survival rate was 54.1%. Forty-two percent of the patients died early after the transplant. The main cause of early mortality was sepsis/multisystem organ failure, and late mortality was related to immunosuppressive therapy noncompliance. The mean patient follow-up was 16 months (range, 0 to 57). Another 36 patients with FHF referred to us died while awaiting LT. Only one patient survived without LT. In conclusion, despite the high mortality rate, urgent LT is still the best therapy for patients with FHF.