Abstract
Orthotopic liver transplantation is employed as salvage therapy for individuals who are unable to recover from acute liver failure. Prognostic models are helpful but not entirely accurate in predicting those who will eventually require liver transplantation. There are specific criteria for United Network for Organ Sharing category 1a (urgent) listing of these patients. Unfortunately, clinical deterioration develops rapidly and many require removal from the waiting list prior to transplantation. With advances in critical care management and surgical technique, 1-year post-transplant survival rates have improved to 60 to 80%. Alternatives to conventional orthotopic liver transplantation include living donor liver transplantation, ABO-incompatible grafts, and auxiliary liver transplantation. There are many ethical and psychosocial issues inherent to transplanting these sick patients due to the urgent nature of acute liver failure. Fortunately, the long-term survival and quality of life in these transplant recipients is good.
Highlights
Orthotopic liver transplantation (OLT) was initially developed in the 1960s as treatment for individuals dying of end-stage liver disease
A recent study from the UK suggested that OLT is a more favorable approach to managing patients with non-APAP induced acute liver failure (ALF) compared to patients with APAP induced ALF
Over the past thirty years, with advances in the field of liver transplantation and critical care management, the US 1-year survival rates following OLT for ALF have improved to 60-80% and 1-year post-transplant graft survival rates have improved from 63% to 75% (Bismuth et al, 1995; DeVictor et al, 1992; Hoofnagle et al, 1995; W Lee, 2003; O'Grady et al, 1988; Wigg et al, 2005)
Summary
Orthotopic liver transplantation (OLT) was initially developed in the 1960s as treatment for individuals dying of end-stage liver disease. It began to be utilized in the 1980s as salvage therapy in the setting of acute liver failure (ALF). Over the past thirty years, with advances in critical care management and in the field of liver transplantation, 1-year survival rates following OLT for ALF have improved to 60-80% (Bismuth et al, 1995; DeVictor et al, 1992; Hoofnagle et al, 1995; W Lee, 2003; O'Grady et al, 1988). About half of ALF patients undergo OLT, ALF accounts for less than 10% of US transplants and approximately 11% in Europe (Freeman et al, 2008)
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