Med J Aust 1991 Jun 3;154(11):724-8

Acute and subacute fulminant hepatic failure: the role of liver transplantation

Sheil AG, McCaughan GW, Isai HI, Hawker F, Thompson JF, Dorney SF
Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital,
Camperdown, NSW.

Abstract
OBJECTIVES: To report the experience of the Australian National Liver Transplant
Unit with patients with fulminant hepatic failure and to describe the role of
liver transplantation. PATIENTS: Twenty-seven patients presented with acute or
subacute fulminant hepatic failure during the period from January, 1986, to
March, 1990. Twenty-two had acute and five had subacute fulminant hepatic
failure. The causes were hepatitis B in 10 patients, presumed non-A, non-B
(NANB) hepatitis in eight patients, drug-induced hepatic damage in five
patients, and Wilson's disease in four patients. There were 13 males and 14
females. Ages were 2-43 years (mean, 23). Twenty patients (74%) were in grade IV
encephalopathy on presentation. RESULTS: Six patients (22%) began to improve
soon after admission and went on to full recovery. Spontaneous recovery was more
frequent in patients with drug-induced hepatic damage (four patients [80%]) and
was less frequent in those with hepatitis B (one patient [10%]) and NANB
hepatitis (one patient [12%]). The other 21 patients (78%) were considered for
orthotopic liver transplantation. Eight (30%) were judged to be unsuitable and
went on to early death. Thirteen (48%) were suitable for transplantation. Of
these five (19%) died before a liver donor became available and eight (30%)
received liver grafts and went on to full recovery. Overall, 14 patients (52%)
survived and 13 (48%) died. Patients with Wilson's disease (four [100%]) were
most suitable for orthotopic liver transplantation whereas eight (44%) of those
with hepatitis B or NANB hepatitis were unsuitable. Of the eight patients
receiving liver grafts one had hepatitis B, three had NANB hepatitis and four
had Wilson's disease. Five were in grade IV encephalopathy at the time of
operation. The mean waiting time for transplantation was 6.4 days. Five patients
received ABO blood group compatible grafts and three received ABO incompatible
grafts. Of the latter group, two subsequently required secondary orthotopic
liver transplantation with ABO compatible grafts. All eight patients who
received transplants are alive and well 3-24 months after the operation. No
patient has any neurological sequelae. CONCLUSIONS: Orthotopic liver
transplantation is a preferred option for patients with fulminant hepatic
failure whose condition is not responding to conservative management. ABO
incompatible livers transplanted in emergency circumstances may prove
life-saving either by functioning successfully or by providing time during which
ABO compatible grafts become available.(ABSTRACT TRUNCATED AT 400 WORDS)