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Liver Transplantation - part 4

Tất cả các nguyên nhân khác: prothrombin thời gian 50 giây (không phân biệt của bệnh não cấp) hoặc Bất kỳ ba của các biến sau đây (không phân biệt cấp bậc của các bệnh não): Tuổi 40 năm suy gan do halothane hoặc thuốc khác Thời gian tật riêng hoặc vô căn bệnh viêm gan vàng da trước khi bệnh não | 32 Liver Transplantation Criteria for determining the prognosis of fulminant hepatic failure are shown below Table 7 . Table 7. Prognostic criteria for predicting requirement of liver transplantation in patients with fulminant hepatic failure 3 Acetaminophen Toxicity pH 7.3 irrespective of grade of encephalopathy or Prothrombin time 50 seconds and serum creatinine 3.4 mg dL 300 pmol L in Patients with grade III or IV encephalopathy Arterial blood lactate 3.5 mmol l is associated with a high mortality. All Other Causes Prothrombin time 50 seconds irrespective of grade encephalopathy or Any three of the following variables irrespective of grade of encephalopathy Age 10 years or 40 years Liver failure due to halothane or other drug idiosyncrasy or idiopathic hepatitis Duration of jaundice prior to encephalopathy 7 d Prothrombin time 25 seconds Serum bilirubin 17.5 mg dL 300 pmol L Adapted from O Grady et al. Gastroenterology 1989 97 439. The prothrombin time thresholds have been reduced for application in the US due to differences in laboratory methods to assay prothrombin time between Europe and US. In Europe prothrombin times should be multiplied by 2. These criteria separate acetaminophen-induced FHF from all other causes. Drug-induced hepatic failure other than that caused by acetaminophen has a poor prognosis. Examples include hepatic failure due to phenytoin or halothane. HBV-and HAV-induced hepatic failure have a better outcome than idiopathic presumed viral fulminant hepatic failure. Patients younger than 2 years or older than 40 years have a poor prognosis. Renal failure is also a poor prognostic factor. Some have recommended serum factor V levels as an indicator of when to proceed to transplant. A factor V level of less than 20 is a poor prognostic indicator. Acidosis is a valuable prognostic factor particularly in acetaminophen- induced fulminant hepatic failure. Whilst listed and awaiting a suitable donor organ the patient may deteriorate sepsis .