İlgin Özden1, Hacer Aysen Yavru2, Özlem Durmaz3, Günseli Orhun2, Artür Salmaslıoğlu4, Mine Güllüoğlu5, Aydın Alper6, Cem İbiş6, Kürşat Rahmi Serin6, Zerrin Önal3, Perihan Ergin Özcan2, Arzu Poyanlı4, Selda Hançerli7, Atahan Çağatay8, Serdar Cantez3, Sabahattin Kaymakoğlu9. 1. Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi-Çapa-Şehremini, 34390, İstanbul, Turkey. iozden@hotmail.com. 2. Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 3. Department of Pediatrics(Gastroenterology), Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 4. Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 5. Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 6. Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi-Çapa-Şehremini, 34390, İstanbul, Turkey. 7. Department of Pediatrics (Infectious Diseases), Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 8. Department of Infectious Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 9. Department of Internal Medicine (Gastroenterology), Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Abstract
BACKGROUND: Living donor liver transplantation may complement cadaveric transplantation in acute liver failure (ALF) patients. METHODS: Between 2008 and 2017, 89 patients were treated for ALF; 15 patients (17%) recovered with intensive care treatment; 31 (35%) died without transplant. The records of the remaining 43 patients (median (range) age: 14 (1-62)) who underwent transplantation were evaluated. RESULTS: The etiologic factors were toxic agents (10; mushrooms: 8; herbs: 2), hepatitis viruses (7; A: 1; B: 6), Wilson's disease (7), autoimmune hepatitis (4), and Budd-Chiari syndrome (2); 13 cases were idiopathic. Cadaveric organs (whole, split, reduced) were transplanted to 32 patients; 11 patients underwent living donor transplantation. One patient (2%) died of septic shock on the second postoperative day. Bacterial infection was the most common early (< 3 months) complication in the remaining patients (31/42; 74%), followed by delirium (5/42; 12%) and acute rejection requiring steroid pulse (5/42; 12%). Seven other patients died during median (range) follow-up of 94 (14-142) months: various infections (5), leukemia (1), and acute myocardial infarction (1). The 1-, 5-, and 10-year survival rates were 100%, 96%, and 92% in children and 94%, 82%, and 65% in adults respectively. CONCLUSIONS: Cadaveric organ sharing and transplantation from living donors when appropriate yield a high survival rate, despite high early morbidity, in ALF patients whose conditions deteriorate despite intensive care treatment. Efforts to eliminate preventable causes of acute liver failure will lead to more efficient use of health care resources.
BACKGROUND: Living donor liver transplantation may complement cadaveric transplantation in acute liver failure (ALF) patients. METHODS: Between 2008 and 2017, 89 patients were treated for ALF; 15 patients (17%) recovered with intensive care treatment; 31 (35%) died without transplant. The records of the remaining 43 patients (median (range) age: 14 (1-62)) who underwent transplantation were evaluated. RESULTS: The etiologic factors were toxic agents (10; mushrooms: 8; herbs: 2), hepatitis viruses (7; A: 1; B: 6), Wilson's disease (7), autoimmune hepatitis (4), and Budd-Chiari syndrome (2); 13 cases were idiopathic. Cadaveric organs (whole, split, reduced) were transplanted to 32 patients; 11 patients underwent living donor transplantation. One patient (2%) died of septic shock on the second postoperative day. Bacterial infection was the most common early (< 3 months) complication in the remaining patients (31/42; 74%), followed by delirium (5/42; 12%) and acute rejection requiring steroid pulse (5/42; 12%). Seven other patientsdied during median (range) follow-up of 94 (14-142) months: various infections (5), leukemia (1), and acute myocardial infarction (1). The 1-, 5-, and 10-year survival rates were 100%, 96%, and 92% in children and 94%, 82%, and 65% in adults respectively. CONCLUSIONS: Cadaveric organ sharing and transplantation from living donors when appropriate yield a high survival rate, despite high early morbidity, in ALFpatients whose conditions deteriorate despite intensive care treatment. Efforts to eliminate preventable causes of acute liver failure will lead to more efficient use of health care resources.
Authors: Riad Lutfi; Kamal Abulebda; Mara E Nitu; Jean P Molleston; Molly A Bozic; Girish Subbarao Journal: J Pediatr Gastroenterol Nutr Date: 2017-05 Impact factor: 2.839
Authors: Giacomo Germani; Eleni Theocharidou; Renè Adam; Vincent Karam; Julia Wendon; John O'Grady; Patrizia Burra; Marco Senzolo; Darius Mirza; Denis Castaing; Jurgen Klempnauer; Stephen Pollard; Andreas Paul; Jacques Belghiti; Emmanuel Tsochatzis; Andrew K Burroughs Journal: J Hepatol Date: 2012-04-18 Impact factor: 25.083