Liver transplantation for acute liver failure: a 5 years experience

Abstract

-Background -Fulminant hepatic failure carries a high morbidity and mortality. Liver transplantation has markedly improved the prognosis of patients with fulminant hepatic failure. Aim -To evaluate the outcome of 20 patients with acute liver failure and indication for liver transplantation. Methods -A retrospective review of 20 patients with acute liver failure and indication for liver transplantation was performed. Patients were divided into two groups: group A with 12 patients who underwent liver transplantation and group B with 8 patients who did not receive liver transplantation. Both groups were analyzed according to age, sex, ABO blood type, etiology of acute liver failure, time on list until transplantation or death, and survival rates. Group A patients were additionally analyzed according to preoperative INR, AST, and ALT peak values and MELD (Model for End-stage Liver Disease) scores; intraoperative red blood cells and plasma transfusion and cold ischemia time; postoperative lenght of intensive care unit and hospital stay, and needed for dialysis. Results -Group A: there were four men and eight women with an average age of 24.6 years. The average liver waiting time period was 3.4 days and MELD score 36. Seven patients are alive with good hepatic function at a medium follow-up of 26.2 months. The actuarial survival rate was 65.2% at 1 year. Group B: There were two men and six women with an average age of 30.9 years. The mean waiting time on list until death was 7.4 days. All patients died while waiting for a liver donor. Conclusion -Despite the improvements in intensive care management, most patients with acute liver failure and indication for liver transplantation ca not survive long without transplant. Liver transplantation is potentially the only curative modality and has markedly improved the prognosis of those patients.

Impact of acute kidney injury exposure period among liver transplantation patients

“…This analysis was limited to this time frame to avoid selection bias, related to the introduction of MELD (Model for End-stage Liver Disease) allocation criteria. Cases taken as urgent, such as patients with acute liver failure or graft primary nonfunction, were prioritized and received the first suitable organ available within the state area [10]. All transplantation recipients were admitted to the intensive care unit (ICU) in the immediate postoperative period.…”

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“…Many factors may play a role in morbidity and mortality duration of OLT. 5,6 On the other hand, a pediatric liver transplant is expensive for a medical center, owing to the cost of the intensive care. 7 Patients with FHF have a survival rate between 60% and 76% 6 ; our patients with FHF had a survival rate of 81.8% 1 year after OLT.…”

Perfil dos pacientes com transplante hepático devido à insuficiência hepática aguda atendidos no Hospital Universitário Walter Cantídio

“…Constatando-se então uma possível incidência aumentada de IHA em populações mais jovens; ou hepáticas agudas na casuística do HUWC, é patente e expressivo a predominância de casos sobre o sexo feminino; cuja prevalência em nossa amostra foi de 90,5% em contraste com os 9,5% de homens com IHA, à semelhança de outros estudos. 2,11 de mais idade quando comparados a pacientes mais jovens.…”

“…A maioria dos estudos sugerem que menos de 15% dos pacientes sobrevivem sem o transplante de fígado, apesar das melhorias na gestão de cuidados intensivos. O TxH melhorou 2 As taxas de mortalidade permanecem altas em razão da IHF. No entanto, reduziram com o decorrer dos anos, devido ao maior conhecimento sobre a patologia, terapias médicas mais agressivas, aprimoramento dos cuidados e advento do TxH.…”