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LIVER TRANSPLANTATION FOR FULMINANT HEPATIC-FAILURE - IMPORTANCE
OF RENAL FAILURE
One hundred eighty-one consecutive patients with fulminant
hepatic failure (FHF) presenting in a 2-year period were reviewed.
In this cohort we examined the impact of pretransplant renal
failure on mortality and morbidity following orthotopic liver
transplantation (OLTx). Twenty-seven patients (18 female, 9 male)
with a median age of 43.5 years (range 19-65 years) underwent OLTx.
FHF was due to idiosyncratic drug reaction (n = 4), paracetamol
overdose (n = 3), seronegative hepatitis (n = 17), hepatitis B (n =
1), veno-occlusive disease (n = 1), and Wilson's disease (n = 1).
Renal failure was present in 14 patients, 7 of whom died (whereas
there was 100 % survival in patients without renal failure).
Pretransplant renal failure was associated with prolonged
mechanical ventilation (13 days vs 6 days, P = 0.05), prolonged
intensive care stay (17 days vs 8 days, P = 0.01) and prolonged
hospital stay (27 vs 21 days, P = NS). Pretransplant re nal failure
did not predict renal dysfunction at 1 year after OLTx. We conclude
that the survival of patients transplanted for FHF is inferior to
that of patients transplanted for chronic liver disease (67 % vs 88
% 1-year survival in Birmingham). For patients with FHF undergoing
transplantation; pretransplant renal failure strongly predicts poor
outcome with significantly greater consumption of resources.
Author: DJ MUTIMER, QUEEN ELIZABETH HOSP, LIVER &
HEPATOBILIARY UNIT, BIRMINGHAM B15 2TH W MIDLANDS
Source: TRANSPLANT INTERNATIONAL 1997 JAN;10(1):55-60
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