Fulminant hepatic failure is a common indication for liver transplantation.
In this study, researchers from Scandinavia assessed the outcomes of patients listed for a highly urgent liver transplantation.
They placed special emphasis on etiology of the liver disease, clinical condition, and ABO blood type.
The team collected all data from the Nordic Liver Transplantation Registry.
All Nordic patients listed for a highly urgent primary liver transplantation during a 12-year period were included in the study.
The research team assessed a total of 315 patients listed for a highly urgent liver transplantation.
Of these, 73% received a first liver allograft, 16% died without transplantation, and 11% were permanently withdrawn and survived.
In 43% of the patients, the researchers were unable to establish a definite etiology of their liver failure.
|Acetaminophen intoxication is the single independent predictor of outcome without transplantation.|
However, acetaminophen (paracetamol) intoxication was the most frequent specific indication for listing.
The team found that patients with blood type A had no significant shorter waiting time but a higher rate of transplantation, when compared with blood type O patients.
In a multivariate analysis, acetaminophen intoxication remained the single independent predictor of an outcome without transplantation.
Dr Bjørn Brandsæter's team concluded, "A high transplantation rate was observed among patients listed for a highly urgent liver transplantation because of fulminant hepatic failure".
"Blood type O patients had a lower chance of receiving a liver allograft".
"Patients with paracetamol intoxication had both a higher mortality without transplantation and a higher withdrawal rate attributable to improved condition".
In a related editorial, Drs Frank Vinholt Schiødt and William Lee, from the University of Texas Southwestern Medical Center, Texas, USA, discuss the previous study.
Reliable prognostic markers of outcome are highly needed in emergency liver transplantation for acute liver failure, they conclude.