Fulminant hepatic failure: U.S.A. experience

Viral hepatitis is the predominant etiology of fulminant hepatic failure in the United States. Non-A, non-B hepatitis cases are also non-E and non-C; the etiology of the majority of these presumptive viral hepatitis cases remains indeterminate. A subset of these patients may be infected with a HBV variant. HBV precore mutants are responsible for a minority of fulminant hepatitis B. The diagnostic and aggressive treatment of cerebral edema has become paramount in the management of fulminant hepatic failure. Epidural transducers are the preferred monitors and are associated with less complications (i.e. bleeding, infection). Orthotopic liver transplantation has evolved as the standard treatment for this condition. The one-year survival is approximately 60% and continues to be lower than among patients with chronic liver diseases (85%). Fulminant hepatic failure is the indication in 7% of the patients undergoing transplantation. The selection and timing of this procedure continues to be a challenge to hepatologists. Artificial liver support systems are evolving around the development of biomembranes. Cell cultures have been derived from human or porcine origin. Preliminary results are promising, and we may expect these systems to provide a bridge to transplantation or full recovery of the native organ.