Current issues and treatment of fulminant hepatic failure including transplantation in Hong Kong and the Far East

In the Far East, fulminant hepatic failure is mainly due to viral hepatitis. In areas where hepatitis B infection is endemic, exacerbation of chronic hepatitis B infection, either spontaneously or on withdrawal of immunosuppressive therapy, is the major cause of fulminant hepatic failure. For hepatitis B surface antigen (HBsAg)-positive patients treated with intense immunosuppressive or cytotoxic therapy, preemptive use of lamivudine has drastically reduced the incidence of hepatitis due to hepatitis B exacerbation. Recently, the application of orthotopic liver transplantation, in particular living donor liver transplantation, has markedly improved the survival of patients with fulminant hepatic failure. In Hong Kong, the phenomenon of adoptive transfer of immunity to hepatitis B virus in liver transplantation has recently been reported. The mechanisms by which transfer of immunity occurs and its potential relationship with grafts from living related donors should be further explored.