Q J Med 1988 Oct;68(258):817-24

Outcome of orthotopic liver transplantation in the aetiological and clinica
variants of acute liver failure

O'Grady JG, Alexander GJ, Thick M, Potter D, Calne RY, Williams R

Abstract
Thirty-three patients with acute liver failure underwent orthotopic liver
transplantation, including 16 with fulminant hepatic failure, 15 with late-onset
hepatic failure and two with severe acute liver failure (coagulopathy without
encephalopathy). Twenty-three (70 per cent) survived to leave hospital and 21 of
these are currently alive and well. Outcome correlated with the serum bilirubin
level before transplantation (p less than 0.05) but no correlation was found
with the variant of acute liver failure, grade of encephalopathy, cerebral
oedema, serum creatinine, white cell count, prothrombin time or platelet count
at the time of transplantation. Severe coagulation factor deficiencies did not
constitute a clinical problem. One patient developed a neurological deficit
secondary to cerebral oedema, but otherwise the morbidity reflected that
observed in the general population after transplantation. Careful monitoring of
intracranial pressure and surveillance (with early aggressive therapy) for
bacterial and fungal infections is very important in achieving a successful
outcome after transplantation