Fulminant hepatic failure (FHF) is a clinical problem with a high mortality rate.
Liver transplantation (LT) is the treatment of choice for irreversible FHF. However, few investigations have examined pre-transplant variables that may predict outcome after LT.
In this study, researchers from Los Angeles, California, analyzed outcomes after LT in patients with FHF. They assessed pre-transplant variables that could potentially help predict post-transplant outcome.
The research team undertook a retrospective review of all patients undergoing LT for FHF at a single transplant center. Median follow-up was 41 months.
They analyzed 35 variables, using univariate and multivariate methods, in order to determine their impact on patient and graft survival.
|1- and 5-year patient survival rates were 73% and 67%.|
|Annals of Surgery|
Overall, 204 patients (60% female, median age 20.2 years) required urgent LT for FHF.
The researchers found that before LT, 76% of patients were comatose, 16% were on hemodialysis and ICU-bound.
The team determined that the 1- and 5-year patient survival rates were 73% and 67%, respectively. The 1- and 5-year graft survival rates were 63% and 57%, respectively.
The primary cause of patient death was sepsis, and the primary cause of graft failure was primary graft nonfunction.
The team's univariate analysis of pre-LT variables revealed 19 variables which predicted survival. From these results, multivariate analysis determined that the serum creatinine was the single most important prognosticator of patient survival.
Dr Douglas Farmer's team concluded, "This study…demonstrates a long-term survival of nearly 70%, and develops a clinically applicable and readily measurable set of pre-transplant factors that determine post-transplant outcome".