Fulminant and Subfulminant Liver Failure: Definitions and Causes

Abstract

Fulminant or subfulminant liver failure, complicated by encephalopathy and in many cases by death is seen to be a syndrome that may result from numerous causes. Although viral hepatitis, drug-induced hepatitis, and hepatitis due to various types of poisonings, in decreasing frequency, account for 90% of all cases, a variety of miscellaneous conditions account for the remainder. Consideration of the possibility of these less common etiologies by the clinician is of considerable importance, since some, including massive malignant involvement (such as leukemia) or acute fulminant Wilson's disease, may respond to specific treatment measures. Thus, unless hepatic transplantation proves to be applicable in FHF of many etiologic diagnosis may continue to have important therapeutic indications in at least some cases with this syndrome.

Orthotopic liver transplantation for acute and subacute hepatic failure in adults

“…It should be noted in addition, however, that with the exception of this report, no case of fulminant Wilson's disease has been reported to survive to date without OLTx. It should also be noted that only those who use less restrictive definitions of fulminant and subacute hepatic failure (e.g., not requiring the obligate presence of deep Stage 3 or Stage 4 coma) have reported survival rates of between 33 and 70%, which are comparable to what we have found in advanced stages of hepatic encephalopathy (1,3,5,10,(23)(24)(25)(26)(27)(28). Clearly, the role of liver transplantation in patients having less severe fulminant or subacute hepatic dysfunction but not in advanced Grade 3 or 4 hepatic encephalopathy but rather in Stage 2 and early Stage 3 remains to be determined.…”

“…It is of some interest to note moreover that the single survivor of acute fulminant type B hepatitis became hepatitis B surface antibody-positive postoperatively and is currently working full time free of any clinical or biochemical evidence of liver disease. Finally, it should be noted that liver failure, particularly its fulminant and subacute hepatic forms, is not a homogenous condition and that survival is known to be influenced by the underlying etiology (23,24). In fact, the mix of patients herein reported is somewhat unusual, with 9 of the 29 having had fulminant Wilson's disease.…”

Living-related liver transplantation for patients with fulminant and subfulminant hepatic failure

“…We adopted the definitions of FHF and SFHF given by Bernuau et al 11 ; FHF was defined as acute liver failure complicated by hepatic encephalopathy less than 2 weeks after the onset of jaundice, and SFHF as acute liver failure complicated by encephalopathy 2 weeks to 3 months after the onset of jaundice. Because liver transplantation is not a common treatment for FHF in Japan, most patients with FHF are given intensive care including many sessions of plasmapheresis using a large amount of fresh frozen plasma, as well as long-term continuous hemodiafiltration.…”

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“…The diagnosis of acute liver failure is made clinically on the basis of physical examination findings such as altered mental status and supportive laboratory results like prolonged prothrombin time [3]. The most commonly identified causes of acute liver failure include medications and idiosyncratic drug toxicity, initial presentation of autoimmune hepatitis and viral infections [4][5][6][7] also we should keep in mind other possibilities for example Eclampsia, Fatty liver of pregnancy, Hepatic ischemia, Malignant infiltration, Toxins and/or Wilson disease [4,[8][9][10].…”