Cadaveric liver transplantation for fulminant liver failure

Fulminant liver failure (FLF) is a life-threatening condition. The mortality rate among patients with developed fulminant liver failure reaches 70 %. Performing liver transplantation from a posthumous donor for fulminant liver failure, the mortality rate, according to various sources, reaches 25.4 – 38.1 %. Up to 25 % of patients with acute liver failure die on the cadaveric liver waiting list without receiving a transplant. In presented clinical case, a 16-year-old patient developed fulminant liver failure in the absence of chronic diseases. Despite the syndromic therapy, hepatic, kidney and cardiovascular failure progressed. The developed depression of consciousness and respiratory failure required the transfer of the patient to artificial ventilation. Coma and multiple organ failure were diagnosed. As a result of interdepartmental cooperation, the patient urgently underwent liver transplantation from a cadaveric donor. The postoperative period proceeded without complications. On the 36th day, the patient was discharged in satisfactory condition for the outpatient stage of treatment. To date, liver transplantation is the only effective and radical treatment for fulminant liver failure.

1. Marsh K., Tayler R., Pollock L. et al. Investigation into cases of hepatitis of unknown aetiology among young children, Scotland, 1 January 2022 to 12 April 2022. Euro Surveill. 2022;27(15):2200318. DOI: 10.2807/1560-7917.ES.2022.27.15.2200318.

2. UK Health Security Agency. Increase in acute hepatitis cases of unknown aetiology in children. London: UK Health Security Agency. URL: https://www.gov.uk/government/publications/hepatitis-increase-in-acute-casesof-unknown-aetiology-in-children/increase-in-acute-hepatitis-cases-ofunknown-aetiology-in-children (accessed: 10.06.24).

3. Update: Hepatitis of unknown origin in children.

4. European Centre for Disease Prevention and Control. URL: https://www.ecdc.europa.eu/en/news-events/update-hepatitis-unknown-originchildren (accessed: 10.06.24).

5. World Health Organization (23 April 2022). Disease Outbreak News; Multi-Country – Acute, severe hepatitis of unknown origin in children. URL: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON376 (accessed: 10.06.24).

6. Tetova V. B., Burgasova O. A., Volkova V. M., Belyaeva N. M. Interdisciplinary approach to the syndrome of acute hepcenary failure.. Epidemiology and infectious Diseases, Russian journal. 2017;22(3):144‒152. (In Russ.). DOI: 10.18821/1560-9529-2017-22-3-144-152.

7. Simpson K. J., Bates C. M., Henderson N. C. et al. The utilization of liver transplantation in the management of acute liver failure: comparison between acetaminophen and non-acetaminophen etiologies. Liver Transpl. 2009;15:600–9.

8. O’Grady J. G., Alexander G. J., Hayllar K. M., Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97:439–45.

9. McPhail M. J. W., Wendon J. A., Bernal W. Meta-analysis of performance of Kings’ College Hospital Criteria in prediction of outcome in nonparacetamol-induced acute liver failure. J. Hepatol. 2010;53:492–9.

10. Germani G., Theocharidou E., Adam R. et al. Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. J. Hepatol. 2012;57:288–96.

11. Moon D.-B., Lee S.-G., Kang W.-H. et al. Adult living donor liver transplantation for acute-on-chronic liver failure in high-model for end-stage liver disease score patients. Am. J. Transplant. 2017;20:1–10.

12. Cabeza de Vaca V. G., Bellido C. B., Martínez J. N. A. et al. Liver transplantation due to fulminant hepatic failure. Transplant. Proc. 2012;44(7):2076–2077.

13. Gautier S. V., Konstantinov B. A., Tsirulnikova O. M. Transplantatsiya pecheni. Мoscow, МIА, 2008:246.

14. Petrasek J., Jirsa M., Sperl J. et al. Revised King’s College score for liver transplantation in adult patients with Wilson’s disease. Liver Transplan. 2007;13:55.

15. Thomas J. A. Macrophage therapy for murine liver fibrosis recruits host effector cells improving fibrosis, regeneration and function. Hepatology. 2011;53(6):2003–2015.

16. Stutchfield B. M., Simpson K., Wigmore S. J. Systematic review and meta-analysis of survival following extracorporeal liver support. Br. J. Surg. 2011;98:623–31.

17. Tritto G., Davies N. A., Jalan R. Liver replacement therapy. Semin. Respir. Crit. Care Med. 2012;33:70–9.

18. Saliba F., Camus C., Durand F. et al. Albumin dialysis with a noncell artificial liver support device in patients with acute liver failure: a randomized, controlled trial. Ann. Intern. Med. 2013;159:522–31.

19. Demetriou A. A., Brown R. S. Jr., Busuttil R. W. et al. Prospective, randomized, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Ann. Surg. 2004;239:660–7.

20. Larsen F. S., Schmidt L. E., Wendon J. et al. Liver assisting with highvolume plasma exchange in patients with acute liver failure. Hepatology. 2010;52:376A–376A.