Background: Early mortality and retransplantation rates following liver transplantation for fulminant hepatic failure (FHF) are high. We investigated possible reasons for these findings.
Methods: Data were obtained from the liver transplantation database of the United Network for Organ Sharing (UNOS) Scientific Registry. Recipient information was limited to waiting time; diagnosis; demographic, laboratory and serologic data; and six UNOS functional status codes. Donor information included demographic characteristics, cause of death, ABO blood type, and serology test results. Comparisons between FHF and non-FHF were carried out for children and adults separately. The influence of an FHF diagnosis on 1-year patient and graft survival was examined using the Cox proportional hazard model. The same model was used to determine independent predictors of outcome following transplantation for FHF.
Results: The majority of FHF recipients were on pretransplant life support, had much shorter waiting times, and were less well matched for ABO blood type (especially the children) than their non-FHF counterparts. Although 1-year survival and graft survival were significantly lower, the significance of these differences was eliminated when the initial recipient, donor and matching characteristics between the two groups were controlled in the analysis. For FHF recipients, ABO mismatch and abnormal kidney function were the strongest independent predictors of adverse outcome.
Conclusions: The results of this study provide circumstantial evidence that patients with FHF derive as much benefit from liver transplantation as patients with other diagnoses of comparable severity.