Twenty-four patients were transplanted for fulminant hepatic failure at the University of Nebraska Medical Center from 1986 (July) to 1988. Long-term survival is about 58%. FHF is an increasingly common indication for liver transplantation. Cerebral edema, organ availability, and late referral are obstacles to improved survival. Randomized trials have not been performed to demonstrate that transplantation is superior toother therapies. For some etiologies, such as acute Wilson's disease, in which mortality is 100%, transplantation is clearly indicated. For other etiologies, such as acetaminophen-induced FHF, in which clear gains in survival have been shown using more conservative therapies, the decision to transplant patients becomes more difficult. As all forms of therapy improve, all patients will benefit.
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