Fulminant hepatic failure: etiology and indications for liver transplantation

Fulminant hepatic failure is characterized by the development of severe liver injury with impaired synthetic capacity and encephalopathy in patients with previous normal liver or at least well compensated liver disease. The etiology of fulminant hepatic failure refers to a wide variety of causes, of which toxin-induced or viral hepatitis are most common. In spite of specific therapeutic options in distinctive etiologies, orthotopic liver transplantation is the only therapy proven to improve patient survival in the majority of patients. The outcome is determined by the complications like severe coagulopathy, infections, renal impairment or increased intracranial pressure. The decision for transplantation depends on the possibility of spontaneous hepatic recovery, which may be estimated by several factors. The most important variables for predicting the need of transplantation in fulminant hepatic failure are the degree of encephalopathy, patients age and the underlying cause of liver failure.