A Single Center Experience of Living Donor Liver Transplantation for Acute Liver Failure.

Abstract

Introduction: Acute liver failure is a rare but life-threatening critical illness that occurs most often in patients without chronic liver disease.In Japan, acute liver failure usually consists of fulminant hepatitis due to viral infection, autoimmune hepatitis and drug-allergy-induced liver injury. It is classified into acute or subacute type, in which the encephalopathy occurs within 10 days, or later than 11 days, respectively, of the onset of disease symptoms. The prognosis of acute liver failure is poor unless an urgent liver transplantation is performed. Herein we report our experience of living donor liver transplantation for acute liver failure. Methods:We retrospectively reviewed 13 cases from July 2003 to September 2013 with acute liver failure, analyzing indications, short-term complications, and long-term outcomes. For the selection criteria in patents with acute liver failure to have a transplant, we used the 2008 Guidelines of the Acute Liver Failure Study Group of Japan. Results: The study group was 69.2% (n=9) adult, and 30.8% (n=4) children. The mean age was 32.2 years. It was also classified into 6 acute types, and 7 subacute types. The causes of acute liver failure were hepatitis B (n=5), Wilson disease (n=1), and unknown (n=7). The use of steroid and plasma exchange combined with hemodiafiltration was administered in all cases before liver transplantation. The mean waiting time from appearance of encephalopathy to liver transplantation was 3.8 days. The mean score of the guideline for liver transplantation was 5.5. The pathologic analysis of the all explanted grafts extensively showed degeneration and necrosis of liver tissues. The total mortality rate was 23.1% (n=3) with acute rejection, graft dysfunction, and multiple organ failure after the rupture of esophageal varix. The survival rates of 1,5,and 10 years were 84.6%, 84.6% and 67.7%, respectively. The median follow-up time was 77 months. Conclusion: We performed 13 cases of living donor liver transplantation for acute liver failure. In all cases, persistent or progressive liver dysfunction with encephalopathy was observed despite medical treatment in intensive care unit. Considering the pathological finding in predicting unlikely spontaneous recovery, improvement of prognosis has not been achieved without liver transplantation.