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Liver transplantation for fulminant hepatic failure: experience with more than 200 patients over a 17-year period Farmer DG; Anselmo DM; Ghobrial RM; Yersiz H; McDiarmid SV; Cao C; Weaver M; Figueroa J; Khan K; Vargas J; Saab S; Han S; Durazo F; Goldstein L; Holt C; Busuttil RWAnn Surg 2003[May]; 237 (5): 666-75; discussion 675-6OBJECTIVE: To analyze outcomes after liver transplantation (LT) in patients with fulminant hepatic failure (FHF) with emphasis on pretransplant variables that can potentially help predict posttransplant outcome. SUMMARY BACKGROUND DATA: FHF is a formidable clinical problem associated with a high mortality rate. While LT is the treatment of choice for irreversible FHF, few investigations have examined pretransplant variables that can potentially predict outcome after LT. METHODS: A retrospective review was undertaken of all patients undergoing LT for FHF at a single transplant center. The median follow-up was 41 months. Thirty-five variables were analyzed by univariate and multivariate analysis to determine their impact on patient and graft survival. RESULTS: Two hundred four patients (60% female, median age 20.2 years) required urgent LT for FHF. Before LT, the majority of patients were comatose (76%), on hemodialysis (16%), and ICU-bound. The 1- and 5-year survival rates were 73% and 67% (patient) and 63% and 57% (graft). The primary cause of patient death was sepsis, and the primary cause of graft failure was primary graft nonfunction. Univariate analysis of pre-LT variables revealed that 19 variables predicted survival. From these results, multivariate analysis determined that the serum creatinine was the single most important prognosticator of patient survival. CONCLUSIONS: This study, representing one of the largest published series on LT for FHF, demonstrates a long-term survival of nearly 70% and develops a clinically applicable and readily measurable set of pretransplant factors that determine posttransplant outcome.|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Bilirubin/blood[MESH]|Child[MESH]|Child, Preschool[MESH]|Creatinine/*blood[MESH]|Female[MESH]|Humans[MESH]|Infant[MESH]|Liver Failure/*blood/etiology/mortality/*surgery[MESH]|Liver Transplantation/*mortality[MESH]|Male[MESH]|Middle Aged[MESH]|Multivariate Analysis[MESH]|Prognosis[MESH]|Retrospective Studies[MESH]|Survival Analysis[MESH]|Treatment Outcome[MESH] |
