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Treatment of acute liver failure by liver transplantation



Treatment of acute liver failure by liver transplantation



Verdauungskrankheiten 21(1): 41-48, Januar/Februar



Orthotopic liver transplantation (LTx) with a full-size organ is the treatment of choice for acute liver failure. Reliable criteria for the indication for transplantation have been developed. Depending on the underlying etiology 1-year survival after LTx in acute liver failure ranges between 55% and 70%, in case of paracetamol-induced liver failure even up to 75%. Septic and neurological complications are the most common causes of perioperative morbidity and mortality. In addition, the emergency setting of the transplantation often enforces to accept marginal or blood group incompatible donor organs. This may result in a higher rate of initial nonfunction of the graft and acute rejection. Accordingly, the need for retransplantation is twice as high as in elective liver transplantation. Auxiliary liver transplantation is based on the potential of the native liver to regenerate in fulminant hepatic failure. The survival rates are similar to transplantation with full-size organs. In case of restitutio ad integrum lifelong immunosuppression can be avoided. The drawbacks of auxiliary liver transplantation are the higher rate of vascular and septic complications and the fact that regeneration cannot be predicted. Thus, auxiliary liver transplantation has not yet gained wide acceptance.

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