CAUSES AND CONSEQUENCES OF LIVER TRASPLANTATION FOR FULMINANT HEPATIC FAILURE AT A SINGLE CENTER.

BACKGROUND AND GOAL
Fulminant hepatic failure (FHF) is an acute, life-threatening deterioration of liver function characterized by hepatic encephalopathy, coagulopathy and jaundice in patients without previous liver disease. 
It accounted for 8% of indications for liver transplantation (LT) in Europe (1) according to the latest reports.  The aim of this study is to evaluate outcomes after LT for FHF.
MATERIAL AND METHODS
Data from LT performed between January 2002 and December 2014 at our centre had been retrospectly analysed. 
We have studied the distribution of FHF as an indication for LT over the past few years, the differences in its outcome comparing to other indications of LT and the aetiology of this acute syndrome at our centre. 
RESULTS AND DISCUSSION
A total of 469 patients who underwent LT were analysed. FHF was the indication in 18 of these patients (3,8%). The cause for FHF was unknown in 6 patients (33,3%). Viral hepatitis was found in 6 patients (33,3%): acute hepatitis B (16,6%), acute hepatitis E (11,1%) and acute hepatitis A (5,5%). Autoimmune hepatitis was diagnosed in 3 patients (16,6%), and drug related hepatic failure in another 3 (16,6%).
We found some statistical differences between FHF patients and those who underwent a LT for another cause: age (45,1±12,4 vs. 53,8±8,6 vs.; p<0,01), female gender (72,2% vs. 27,8%). Some basal data were also significantly different: bilirubin (25,8±14,2 vs. 5,5±7,8; p<0,01), INR (3,2±1,4 vs. 1,6±1,1; p<0,01), prothrombine index (21,4±10,9 vs. 58,2±20,7; p<0,01), platelets amount (160.000 ±75436 vs. 88420±58342; p=0,01), MELD classification (31,33±6,8 vs. 16,8±7,3; p<0,01). 
During the surgery there were also some differences between the two groups: the number of red cell transfused (3,9 ± 2,5 vs. 6,3±8,2; p<0,01) and the platelets units infused (0,8±1,9 vs. 2,8±4,5; p<0,01).
We found statistical association between FHF and reactivation of cytomegalovirus (OR 5,48 (95CI 2,07-14,48); p<0,01) and infections (OR 2,98 (95CI 1,13.7,86); p= 0,02): pneumonia, cholangitis, abdominal infection and catheter related infection. 
Survival proportion after one year was found to be similar in patients with FHF and in patients with other indications for LT (82% vs. 77%; p=0,2); this result is probably not significant because our sample size is too small.
CONCLUSION 
Short-term survival after LT for FHF is similar to that of LT for other causes despite higher infectious complications rate.

Causes and consequences of liver transplantation for fulminant hepatic failure at a single center