Selection of patients with acute hepatic failure for liver transplantation remains difficult, and there is no definite proof of a survival effect. We therefore did a retrospective study in 75 consecutive patients referred over a 12-year period. In two-thirds we identified a cause, mostly viruses or drugs. Patients were grouped by the Clichy and King's College criteria. In 20 there was no indication for transplantation. Of the 5 with autoimmune hepatitis, 3 died, significantly differing from the other 15 (P = 0.009). The remaining 55 met our criteria, except 1. All 9 patients with absolute contraindications died. Of the 46 enlisted, 7 died without transplantation. One-year survival after transplantation was 69%, compared with 58% by "intention to treat." For patients enlisted, transplantation reduced mortality by 78% (P = 0.069). The Clichy and King's College criteria reliably predict survival without transplantation, except in autoimmune hepatitis. Our study strongly suggests that transplantation improves survival.

Acute hepatic failure, Liver transplantation, Survival,
Transplant International
Department of Surgery

de Rave, S, Tilanus, H.W, van der Linden, J, de Man, R.A, van den Berg, B.W, Hop, W.C.J, … Metselaar, H.J. (2002). The importance of orthotopic liver transplantation in acute hepatic failure. Transplant International, 15(1), 29–33. doi:10.1007/s00147-001-0369-6