Neth J Med 1991 Apr;38(3-4):131-41

Fulminant hepatic failure: to transplant or not to transplant

de Knegt RJ, Schalm SW
Department of Internal Medicine II, University Hospital Dijkzigt, Rotterdam, The
Netherlands.

Abstract
Despite progress in intensive care regimens and the introduction of various
hepatic support procedures, the survival rate for fulminant hepatic failure
remained around 20%. In the past few years, orthotopic liver transplantation has
increased the survival rate to more than 50% and thus is generally considered
the treatment of choice. However, since about 20% of the patients on standard
therapy recover spontaneously, not all patients presenting with fulminant
hepatic failure should undergo transplantation immediately. Therefore attempts
should be made to identify the patients with "potentially reversible" liver
disease in an early phase. In this article strategies for deciding which therapy
fits the individual patient are proposed. The decision "to transplant or not to
transplant" should be based on residual functioning liver-cell mass (e.g. factor
V is less or greater than 15%), the presence or absence of systemic
complications such as lactic acidosis and renal failure and the aetiology of the
liver disease (e.g. reversible causes such as viral hepatitis B and irreversible
causes such as Wilson's disease). A flow diagram has been constructed