• Douglas G Farmer, Dean M Anselmo, R Mark Ghobrial, Hasan Yersiz, Suzanne V McDiarmid, Carlos Cao, Michael Weaver, Jesus Figueroa, Khurram Khan, Jorge Vargas, Sammy Saab, Steven Han, Francisco Durazo, Leonard Goldstein, Curtis Holt, and Ronald W Busuttil.
• Department of Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, USA. dgfarmer@mednet.ucla.edu
• Ann. Surg. 2003 May 1; 237 (5): 666676666-75; discussion 675-6.

ObjectiveTo analyze outcomes after liver transplantation (LT) in patients with fulminant hepatic failure (FHF) with emphasis on pretransplant variables that can potentially help predict posttransplant outcome.Summary Background DataFHF is a formidable clinical problem associated with a high mortality rate. While LT is the treatment of choice for irreversible FHF, few investigations have examined pretransplant variables that can potentially predict outcome after LT.MethodsA retrospective review was undertaken of all patients undergoing LT for FHF at a single transplant center. The median follow-up was 41 months. Thirty-five variables were analyzed by univariate and multivariate analysis to determine their impact on patient and graft survival.ResultsTwo hundred four patients (60% female, median age 20.2 years) required urgent LT for FHF. Before LT, the majority of patients were comatose (76%), on hemodialysis (16%), and ICU-bound. The 1- and 5-year survival rates were 73% and 67% (patient) and 63% and 57% (graft). The primary cause of patient death was sepsis, and the primary cause of graft failure was primary graft nonfunction. Univariate analysis of pre-LT variables revealed that 19 variables predicted survival. From these results, multivariate analysis determined that the serum creatinine was the single most important prognosticator of patient survival.ConclusionsThis study, representing one of the largest published series on LT for FHF, demonstrates a long-term survival of nearly 70% and develops a clinically applicable and readily measurable set of pretransplant factors that determine posttransplant outcome.

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