[Fulminant XXXX and liver transplantation. Experience of the Hospital Virgen de la Arrixaca].

@entity1 @entity75 @entity879 @entity409 @entity177 @entity1578 @entity1576
INTRODUCTION: Medical treatment for fulminat @entity1578 seeks spontaneous recovery of the liver function, but the results are very discouraging (50-80% mortality). Liver transplantation is an option in @entity1 with a poor evolution despite medical treatment, with survival rates of > 50%. The ideal moment for performing the transplant is controversial, as it should not be done too soon, when the @entity409 is still reversible, or tool late, when the @entity1 is in an irreversible clinical situation. @entity1 AND METHOD: A retrospective review was made of the clinical histories of 34 @entity1 admitted to our hospital with a diagnosis of @entity879 , of whom 26 underwent transplantation. The most frequent cause was viral, with 10 cases (38%); no aetiology at all could be established in 11 cases (42%). Thirteen @entity1 had preoperative complications, the most frequent being @entity177 . As for degree of ABO/DR compatibility, 13 cases were identical (40%), 17 compatible (51%) and the other 3 incompatible (9%). RESULTS: Thirty-three transplants were performed in 26 @entity1 : 4 were retransplants due to chronic rejection, 2 for primary graft failure and 1 for hyperacute rejection. The overall mortality rate was 46% (12 @entity1 ), the most frequent cause of death being infection (50%). The overall actuarial survival rate was 68% at 1 year, 63% at 3 years and 59% at 5 years. The factors of poor prognosis were @entity177 , a grade D electroencephalogram, and @entity75 grades III and IV, the latter being the only prognostic factor identified in the multivariate analysis. The prognostic factors for mortality were a grade D electroencephalogram, @entity75 grades III and IV and @entity1576 , the latter being the only prognostic factor identified in the multivariate analysis. CONCLUSIONS: The achievement of good results with the use of transplantation in the management of @entity879 depends on an optimum selection of transplant candidates, which means identifying them early, i.e. early indication for transplant, reduction in mean waiting time and exclusion of factors of poor prognosis.
