One hundred eighty-one consecutive patients with
fulminant hepatic failure (FHF) presenting in a 2-year period were reviewed. In this cohort we examined the impact of pretransplant
renal failure on mortality and morbidity following orthotopic
liver transplantation (OLTx). Twenty-seven patients (18 female, 9 male) with a median age of 43.5 years (range 19-65 years) underwent OLTx. FHF was due to idiosyncratic
drug reaction (n = 4),
paracetamol overdose (n = 3), seronegative
hepatitis (n = 17),
hepatitis B (n = 1), veno-occlusive disease (n = 1), and
Wilson's disease (n = 1).
Renal failure was present in 14 patients, 7 of whom died (whereas there was 100% survival in patients without
renal failure). Pretransplant
renal failure was associated with prolonged
mechanical ventilation (13 days vs 6 days, P = 0.05), prolonged
intensive care stay (17 days vs 8 days, P = 0.01) and prolonged
hospital stay (27 vs 21 days, P = NS). Pretransplant
renal failure did not predict renal dysfunction at 1 year after OLTx. We conclude that the survival of patients transplanted for FHF is inferior to that of patients transplanted for chronic
liver disease (67% vs 88% 1-year survival in Birmingham). For patients with FHF undergoing
transplantation, pretransplant
renal failure strongly predicts poor outcome with significantly greater consumption of resources.