Liver Transplantation in Acute Liver Failure

Abstract

Acute liver failure – one of the most difficult diseases of hepatology. The complexity of this problem can be explained not only in the extremely bad condition of a patient but also in the rapid development of the life threatening complications, that may be resolved only by liver transplantation. There is the whole range of criteria that helps to determine indications for liver transplantation within acute liver failure, among which King's college and Clichy criteria are most frequently used. The main factor for successful treatment of patients with acute liver failure is high development of organ donation. In this aspect the Republic of Belarus is among the world's leaders. According to preliminary data for 2021 we are on the 9th place in the world. This fact allows us perform about 90 liver transplants every year. For 14 years of the existence of liver transplantation program we performed more than 900 surgeries. It takes us to the 20th place in the world in terms of the number of transplants per 1 million inhabitants. Among these 900 liver transplantations, 75 cases or 8.5 percent were performed upon acute or acute-on- chronic liver failure. Acute liver failure mainly caused by poisoning with amanita phalloides. The results of liver transplantation suggest that the patients with acute liver failure had a higher MELD score before transplantation and were younger. After the surgery patients were more likely to have acute antibody-mediated rejection and ischemic type biliary lesions. The group of patients who needed a salvage re-transplantation had to undergo hemodialysis more often and in 83 percent of cases they had infectious complications, therefore hospital mortality was in 2 times higher than in ALF group. The most common cause of death of these patients was sepsis. This fact confirms that in some cases of liver failure transplantation is not applicable because the patient is too sick for the surgery.

Conclusion. Treatment of patients with ALF should be carried out at the transplant centers. Conservative methods, including extracorporeal detoxification methods (MARS, Prometheus, plasmapheresis), can be used as a “bridge” to liver transplantation and to correct severe early postoperative liver graft dysfunction. The decision on LT should be based on a comprehensive assessment of both the metabolic and synthetic functions of the liver the degree of encephalopathy, and the possibility of receiving a donor organ in the shortest possible time.