Abstract
In order to clarify the indication for liver transplantation (LT), the pathological examination of the liver explants in 52 patients who underwent LT for fulminant hepatic failure (FHF) was performed. The most important indication of LT for FHF was progressive hepatic encephalopathy after intensive medical treatments. The new guidelines by the acute liver failure group of Japan in 2008 and a new prognostic formula using the volume of the explanted liver was examined. The pathological examination of the explanted liver revealed the necrotic ratio, atrophic rates, and functional remnant liver volume. The one year survival rate after LT was 84.9%. In 86% of the patients, the score according to the new guidelines was no less than 5 (the expected mortality rate no less than 80%). The prognostic formula using the liver volume forecast a poor prognosis in 96% patients. The mean atrophic liver rate and necrotic rate were 57% and 64%, respectively. The functional remnant liver volume was less than 35% in 43 patients and the score of new guidelines was no less than 5 in 8 of 9 patients, whose functional remnant liver volume was more than 35%. In conclusion, our indication of LT for FHF was useful and adequate after pathological examination of the explanted liver.
