Transplant International

, Volume 10, Issue 1, pp 55–60 | Cite as

Liver transplantation for fulminant hepatic failure: Importance of renal failure

  • A. Mendoza
  • F. Fernandez
  • D. J. Mutimer
Original Article


One hundred eighty-one consecutive patients with fulminant hepatic failure (FHF) presenting in a 2-year period were reviewed. In this cohort we examined the impact of pretransplant renal failure on mortality and morbidity following orthotopic liver transplantation (OLTx). Twenty-seven patients (18 female, 9 male) with a median age of 43.5 years (range 19–65 years) underwent OLTx. FHF was due to idiosyncratic drug reaction (n = 4), paracetamol overdose (n = 3), seronegative hepatitis (n = 17), hepatitis B (n = 1), veno-occlusive disease (n = 1), and Wilson's disease (n = 1). Renal failure was present in 14 patients, 7 of whom died (whereas there was 100% survival in patients without renal failure). Pretransplant renal failure was associated with prolonged mechanical ventilation (13 days vs 6 days,P = 0.05), prolonged intensive care stay (17 days vs 8 days,P = 0.01) and prolonged hospital stay (27 vs 21 days,P = NS). Pretransplant renal failure did not predict renal dysfunction at 1 year after OLTx. We conclude that the survival of patients transplanted for FHF is inferior to that of patients transplanted for chronic liver disease (67% vs 88% 1-year survival in Birmingham). For patients with FHF undergoing transplantation, pretransplant renal failure strongly predicts poor outcome with significantly greater consumption of resources.

Key words

Fulminant hepatic failure, Renal failure Liver transplantation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ayres R, Ismail T, Angrisani L, Buckels J, Elias E, McMaster P, Neuberger J (1991) Long-term renal function in liver transplantation. Transplant Proc 23: 1469–1470PubMedGoogle Scholar
  2. 2.
    Bromley PN, Hilmi I, Tan KC, Williams R, Potter D (1994) Orthotopic liver transplantation in patients over 60 years old. Transplantation 58: 800–803PubMedGoogle Scholar
  3. 3.
    Caraceni P, Van Thiel DH (1995) Acute liver failure. Lancet 345: 163–169PubMedGoogle Scholar
  4. 4.
    Daas M, Plevak DJ, Wijdicks EFM, Rakela J, Wiesner RH, Piepgras DG, Dunn WF, Steers JL (1995) Acute liver failure: results of a 5-year clinical protocol. Liver Transplant Surg 1: 210–219Google Scholar
  5. 5.
    Devlin J, Wendon J Heaton N, Tan K-C, Williams R (1995) Pretransplantation clinical status and outcome of emergency transplantation for acute liver failure. Hepatology 21: 1018–1024PubMedGoogle Scholar
  6. 6.
    Epstein M (1988) Hepatorenal syndrome. In: Epstein M (ed) The kidney in liver disease. 3rd edn. Williams and Wilkins, Baltimore, pp 89–118Google Scholar
  7. 7.
    Epstein M (1992) The hepatorenal syndrome — newer perspectives. N Engl J Med 25: 1810–1811Google Scholar
  8. 8.
    Farges O, Kalil AN, Samuel D, Saliba F, Arulnaden JL, Debat P, Bismuth A, Castaing D, Bismuth H (1995) The use of ABO-incompatible grafts in liver transplantation: a life-saving procedure in highly selected patients. Transplantation 59:1124–1133PubMedGoogle Scholar
  9. 9.
    Gonwa TA, Morris CA, Goldstein RM, Husberg BS, Klintmalm GB (1991) Long term survival and renal function following liver transplantation in patients with and without hepatorenal syndrome — experience in 300 patients. Transplantation 51: 428–430PubMedGoogle Scholar
  10. 10.
    Gonwa TA, Klintmalm GB, Levy M, Jennings LS, Goldstein RM, Husberg BS (1995) Impact of pretransplant renal function on survival after liver transplantation. Transplantation 59: 361–365PubMedGoogle Scholar
  11. 11.
    Ismail T, Gunson BK, Ferraz-Neto B-H, Mirza DF, Elias E, McMaster P (1995) Outcome of new livers for old patients (abstract). 7th Congress of European Society for Organ Transplantation, Vienna, AustriaGoogle Scholar
  12. 12.
    Jimenez MJ, Cisneros C, Suarez J, Ambros A, Cobo P, Gandara A de la (1994) Renal failure after liver transplantation. Transplantology 5: 6–7Google Scholar
  13. 13.
    Mirza DF, Mohamed R, Mutimer DJ, McMaster P (1996) Timing and candidacy for transplantation in acute liver failure: the European experience. Liver Transplant Surg 1: 182–186Google Scholar
  14. 14.
    Mutimer DJ, Elias E (1992) Liver transplantation for fulminant hepatic failure. In: Boyer JL, Ockner RK (eds) Progress in liver diseases. WB Saunders, Philadelphia, pp 349–367Google Scholar
  15. 15.
    Mutimer DJ, Gunson B, Neuberger J, Buckels J, McMaster P, Elias E (1990) Transplantation for primary biliary cirrhosis — the Birmingham experience. Gut 31:A1204Google Scholar
  16. 16.
    Mutimer DJ, Ayres RCS, Neuberger JM, Davies MH, Holguin J, Buckels JAC, Mayer AD, McMaster P, Elias E (1994) Serious paracetamol poisoning and the results of liver transplantation. Gut 35: 809–814PubMedGoogle Scholar
  17. 17.
    Muto P, Freeman RB, Haug CE, Lu A, Rohrer RJ (1994) Liver transplant candidate stratification systems. Implications for third-party payers and organ allocation. Transplantation 57: 306–308PubMedGoogle Scholar
  18. 18.
    Turcotte JC, Neuberger J (1994) Donor organ retrieval, allocation and logistics. In: Neuberger J, Lucey MR (eds) Liver transplantation: practice and management. BMJ Publishing, London, pp 130–137Google Scholar
  19. 19.
    O'Grady JG, Alexander GJM, Thick M, Potter D, Calne RY, Williams R (1988) Outcome of orthotopic liver transplantation in aetiological and clinical variants of acute liver failure. Q J Med 258: 817–824Google Scholar
  20. 20.
    O'Grady JG, Alexander GJM, Hayllar KM, Williams R (1989) Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 97: 439–445PubMedGoogle Scholar
  21. 21.
    Peleman RR, Gavaler JS, Van Thief DH, Esquivel C, Gordon R, Iwatsuki S, Starzl TE (1987) Orthotopic liver transplantation for acute and subacute hepatic failure in adults. Hepatology 3: 484–489Google Scholar
  22. 22.
    Rakela J, Perkins JD, Gross JB, Hayes DH, Plevak DJ, Krom RAF, Ludwig J (1989) Acute hepatic failure: the emerging role of orthotopic liver transplantation. Mayo Clin Proc 64: 424–428PubMedGoogle Scholar
  23. 23.
    Ring-Larsen H, Palazzo U (1981) Renal failure in fulminant hepatic failure and terminal cirrhosis. A comparison between incidence, types and prognosis. Gut 22: 585–591PubMedGoogle Scholar
  24. 24.
    Schafer DF, Shaw BW Jr (1989) Fulminant hepatic failure and orthotopic liver transplantation. Semin Liver Dis 3: 189–194Google Scholar
  25. 25.
    Stadt J van de, Gelin M, Bourgeois N, De Prez M, Lambilliotte JP (1990) Liver transplantation for fulminant and subacute viral hepatic failure in adults. Transplant Proc 22: 1505–1508PubMedGoogle Scholar
  26. 26.
    Vickers C, Neuberger J, Buckels J, McMaster P, Elias E (1988) Transplantation of the liver in adults and children with fulminant hepatic failure. J Hepatol 7:143–150PubMedGoogle Scholar
  27. 27.
    Williams R, Wendon J (1994) Indications for orthotopic liver transplantation in fulminant hepatic failure. Hepatology 20: 5S-10SGoogle Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • A. Mendoza
    • 1
  • F. Fernandez
    • 1
  • D. J. Mutimer
    • 1
  1. 1.The Liver and Hepatobiliary UnitThe Queen Elizabeth HospitalEdgbastonUK

Personalised recommendations