Gotthardt Daniel, Riediger Carina, Weiss Karl Heinz, Encke Jens, Schemmer Peter, Schmidt Jan, Sauer Peter
Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Nephrol Dial Transplant. 2007 Sep;22 Suppl 8:viii5-viii8. doi: 10.1093/ndt/gfm650.
Fulminant hepatic failure is characterized by the development of severe liver injury with impaired synthetic capacity and encephalopathy in patients with previous normal liver or at least well compensated liver disease. The etiology of fulminant hepatic failure refers to a wide variety of causes, of which toxin-induced or viral hepatitis are most common. In spite of specific therapeutic options in distinctive etiologies, orthotopic liver transplantation is the only therapy proven to improve patient survival in the majority of patients. The outcome is determined by the complications like severe coagulopathy, infections, renal impairment or increased intracranial pressure. The decision for transplantation depends on the possibility of spontaneous hepatic recovery, which may be estimated by several factors. The most important variables for predicting the need of transplantation in fulminant hepatic failure are the degree of encephalopathy, patients age and the underlying cause of liver failure.
暴发性肝衰竭的特征是既往肝脏正常或至少为代偿良好的肝病患者出现严重肝损伤，伴有合成功能受损和脑病。暴发性肝衰竭的病因多种多样，其中毒素诱导或病毒性肝炎最为常见。尽管针对不同病因有特定的治疗选择，但原位肝移植是唯一被证明能提高大多数患者生存率的治疗方法。其预后取决于严重凝血功能障碍、感染、肾功能损害或颅内压升高等并发症。是否进行移植的决定取决于肝脏自发恢复的可能性，这可通过多种因素进行评估。预测暴发性肝衰竭患者是否需要移植的最重要变量是脑病程度、患者年龄和肝衰竭的潜在病因。
