Liver Transplant In Acute Liver Failure – Looking Back Over 10 Years

Abstract Background Acute liver failure (ALF) is the leading cause for emergency liver transplantation (LT) world over. We looked at the profile of cases who required LT for ALF from a single center to identify the possible predictors of poor outcomes. Method ology: During a 10-yr period starting from 2007, 320 cases of ALF were treated at our institution of which 70 (median age 24yrs, Male:Female 1:2) underwent LT. Retrospective analysis of these 70 patients were performed. Results Etiology was identifiable in 73 % (n = 51) of cases [Yellow Phosphorous (YP) poisoning (n=16), Hepatitis A virus (HAV) (n=15), Hepatitis B virus (HBV) (n=5), Hepatitis E virus (HEV) (n=1), Anti-tubercular therapy (ATT) induced (n= 6), Acute Wilson’s (n=3), and Autoimmune (n=5)]. Upon meeting King’s College Hospital criteria, 69 had live donor LT (61 right lobe grafts, 3 left lobe grafts, 5 lefts lateral segment grafts) and one had deceased donor LT. Among these, there were 5 auxiliary partial orthotopic grafts and 4 ABO incompatible transplants. Overall 90-day mortality was 35.7% (n=25), predominantly due to sepsis. Significant risk factors for mortality on multivariate analysis included indeterminate etiology, pre-op renal dysfunction and grade IV hepatic encephalopathy (HE). Cumulative 10-yr survival of the remaining survivors was 95.6% (n=45). Conclusion LT for ALF carries high perioperative mortality (35.7%) in those presenting with indeterminate etiology, pre-op renal dysfunction and Grade IV HE. Nevertheless, if they survive the perioperative period, long term survival is excellent.