AN OVERVIEW OF LIVER TRANSPLANTATION IN ACUTE LIVER FAILURE

Abstract

Background: Acute liver failure (ALF) is a slashing syndrome that has high mortality rate. Liver transplantation (LT) is the treatment that can importantly improve survival rates and the prognoses of hose patients. Our aim was to analyze patient survival rate (PSR) and graft survival rate (GSR) between 2001 to 2011 for patients with ALF in different continents. Material and Methods: We selected 25 articles with higher casuistic in different continents published between 2001–2011 (Fig. 1). In all articles the following subjects about LT were gathered: author; number of patients; etiology; types of liver transplantation (orthotopic liver transplantation [OLT] and living donor liver transplantation [LDLT]); and their PSR and GSR from 1 to 5 years (Fig. 2). Results: 2981 patients underwent LT therapy for ALF: North America (1948), Europe (569), Oceania (193), Asia (192) and South America (79). There were 1021 males and 1735 females (n=2756). The most frequent etiologies were: Paracetamol intoxication, viral hepatitis and drug or toxic reactions. OLT happened 1979 times and LDLT 174 times (n=2153). The overall PSR was 76%, 70%, and 67.8% at 1, 3, and 5 years, respectively, whereas GSR was 70.5%, 57.7%, and 59.5% at 1, 3, and 5 years, respectively. Conclusion: LT dramatically improved the prognosis and the outcome of ALF patients, as without tranplant survival rates were much lower. OLT with a whole graft from a deceased donor is the most effective therapy for ALF. The keys to an optimal outcome include a short waiting time, a large donor pool, good quality grafts, and a dedicated multidisciplinary transplant team. The mortality on the waiting list for deceased donor LT is high, principally in countries where donation rates are low.