Outcome of Orthotopic Liver Transplantation in the Aetiological and Clinical Variants of Acute Liver Failure

Thirty-three patients with acute liver failure underwent orthotopicliver transplantation, including 16 with fulminant hepatic failure,15 with late–onset hepatic failure and two with severeacute liver failure (coagulopathy without encephalopathy). Twenty–three(70 per cent) survived to leave hospital and 21 of these arecurrently alive and well. Outcome correlated with the serumbilirubin level before transplantation (p<0.05) but no correlationwas found with the variant of acute liver failure, grade ofencephalopathy, cerebral oedema, serum creatinine, white cellcount, prothrombin time or platelet count at the time of transplantation.Severe coagulation factor deficiencies did not constitute aclinical problem. One patient developed a neurological deficitsecondary to cerebral oedema, but otherwise the morbidity reflectedthat observed in the general population after transplantation.Careful monitoring of intracranial pressure and surveillance(with early aggressive therapy) for bacterial and fungal infectionsis very important in achieving a successful outcome after transplantation.