A new study on fulminant hepatic failure (FHF), a sudden and severe shutdown of the liver, examined ways of determining early on whether patients would benefit from a transplant as opposed to responding to other medical treatment. The results showed that elevated blood lactate levels indicate a poor prognosis and thus the need for a transplant.
The results of this study appear in the September 2005 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience.
Although it is rare, FHF is the reason that up to 7 percent of liver transplants are performed. However, because life-threatening complications can quickly develop with the disorder, coupled with the fact that some patients recover without having to undergo a transplant, time is of the essence in determining whether or not to perform the surgery. Various criteria have been used to establish a prognosis, the most widely applied of which is the King's College Hospital criteria, which can be helpful in indicating the need for a transplant, but do not predict patients who will not survive without one.
Led by Gerry C. MacQuillin, of the Department of Gastroenterology and Hepatology of the Sir Charles Gairdner Hospital in Nedlands, Australia, while working in Birmingham UK, researchers examined two markers that could play a role in predicting FHF outcomes: serum phosphate and serum blood lactate levels. The study included 83 patients with FHF admitted to the Liver Unit at Queen Elizabeth Hospital in Birmingham, England between August 2000 and March 2003. Patients were divided into those who survived with medical treatment, those who underwent a liver transplant, and those who died. Patients were also grouped according to whether or not they had overdosed on paracetamol (Tylenol), a common cause of FHF. Of the 83 patients, 58 percent survived with medical treatment, 23 percent underwent liver transplants, and 19 percent died. Those who had overdosed on paracetamol had a much higher recovery rate: 73 percent survived with medical treatment, compared to 26 percent of those who had not overdosed.
The results showed that serum phosphate levels were significantly higher in those who died or underwent a transplant, but there was not a significant difference when comparing those who died to those who were treated without having a transplant. Lactate levels were significantly higher during the 12 hour period following admission to the hospital in those who died or underwent a transplant, and this difference was also seen between those who died and those who survived without a transplant, whether or not they had overdosed.