Viana Cyntia Ferreira Gomes, Rocha Tarciso Daniel Santos, Cavalcante Fernanda Paula, Valença José Telmo, Coelho Gustavo Rêgo, Garcia Jose Huygens Parente
Centro de Transplante de Fígado do Ceará, Fortaleza, CE, Brazil.
Arq Gastroenterol. 2008 Jul-Sep;45(3):192-4. doi: 10.1590/s0004-28032008000300004.
Fulminant hepatic failure carries a high morbidity and mortality. Liver transplantation has markedly improved the prognosis of patients with fulminant hepatic failure.
To evaluate the outcome of 20 patients with acute liver failure and indication for liver transplantation.
A retrospective review of 20 patients with acute liver failure and indication for liver transplantation was performed. Patients were divided into two groups: group A with 12 patients who underwent liver transplantation and group B with 8 patients who did not receive liver transplantation. Both groups were analyzed according to age, sex, ABO blood type, etiology of acute liver failure, time on list until transplantation or death, and survival rates. Group A patients were additionally analyzed according to preoperative INR, AST, and ALT peak values and MELD (Model for End-stage Liver Disease) scores; intraoperative red blood cells and plasma transfusion and cold ischemia time; postoperative lenght of intensive care unit and hospital stay, and needed for dialysis.
Group A: there were four men and eight women with an average age of 24.6 years. The average liver waiting time period was 3.4 days and MELD score 36. Seven patients are alive with good hepatic function at a medium follow-up of 26.2 months. The actuarial survival rate was 65.2% at 1 year. Group B: There were two men and six women with an average age of 30.9 years. The mean waiting time on list until death was 7.4 days. All patients died while waiting for a liver donor.
Despite the improvements in intensive care management, most patients with acute liver failure and indication for liver transplantation ca not survive long without transplant. Liver transplantation is potentially the only curative modality and has markedly improved the prognosis of those patients.
暴发性肝衰竭的发病率和死亡率很高。肝移植显著改善了暴发性肝衰竭患者的预后。
评估20例急性肝衰竭且有肝移植指征患者的治疗结果。
对20例急性肝衰竭且有肝移植指征的患者进行回顾性研究。患者分为两组：A组12例接受肝移植，B组8例未接受肝移植。两组均根据年龄、性别、ABO血型、急性肝衰竭病因、等待移植或死亡的时间以及生存率进行分析。A组患者还根据术前国际标准化比值（INR）、谷草转氨酶（AST）和谷丙转氨酶（ALT）峰值以及终末期肝病模型（MELD）评分；术中红细胞和血浆输注量以及冷缺血时间；术后重症监护病房住院时间和住院总时间以及透析需求进行分析。
A组：4例男性，8例女性，平均年龄24.6岁。平均肝等待时间为3.4天，MELD评分为36分。7例患者存活，肝功能良好，中位随访时间为26.2个月。1年时的精算生存率为65.2%。B组：2例男性，6例女性，平均年龄30.9岁。等待肝移植直至死亡的平均时间为7.4天。所有患者在等待肝供体期间死亡。
尽管重症监护管理有所改善，但大多数急性肝衰竭且有肝移植指征的患者若不进行移植无法长期存活。肝移植可能是唯一的治愈方式，且显著改善了这些患者的预后。
