Fulminant Hepatic Failure

Children with fulminant hepatic failure $, without known underlying liver disease, present diagnostic, therapeutic and prognostic challenges, even if liver transplantation is the only curative possibility for most of these patients &. Rapid clinical deterioration frequently makes diagnosis impossible, prior to urgent transplantation. The prognosis for these patients is often unpredictable, and neurological sequels are frequent &. Failure to maintain a cerebral perfusion pressure greater than 50 mmHg and an intracranial  pressure of less than 20 mmHg has been associated with very poor neurological recovery &. Survival following transplantation is significantly decreased in patients with grade IV encephalopathy. Hepatocyte transplantation may provide neurological protection when an organ is not available for transplantation or while awaiting spontaneous recovery &.
The outcome after liver transplantation is not as good as with chronic liver disease, and etiology is the factor that most closely correlates with prognosis &.