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Long‐term outcomes of emergency liver transplantation for acute liver failure

Acute liver failure continues to be associated with a high mortality rate, and emergency liver transplantation is often the only life‐saving treatment. The short‐term outcomes are decidedly worse in comparison with those for nonurgent cases, whereas the long‐term results have not been reported as extensively. We report our center's experience with urgent liver transplantation, long‐term survival, and major complications. From 1994 to 2007, 60 patients had emergency liver transplantation for acute liver failure. The waiting list mortality rate was 6%. The mean waiting time was 2.7 days. Post‐transplantation, the perioperative mortality rate was 15%, and complications included neurological problems (13%), biliary problems (10%), and hepatic artery thrombosis (5%). The 5‐ and 10‐year patient survival rates were 76% and 69%, respectively, and the graft survival rates were 65% and 59%. Recipients of blood group–incompatible grafts had an 83% retransplantation rate. Univariate analysis by Cox regression analysis found that cerebral edema and extended criteria donor grafts were associated with worse long‐term survival. Severe cerebral edema on a computed tomography scan pre‐transplant was associated with either early mortality or permanent neurological deficits. The keys to long‐term success and continued progress in urgent liver transplantation are the use of good‐quality whole grafts and a short waiting list time, both of which depend on access to a sufficient pool of organ donors. Severe preoperative cerebral edema should be a relative contraindication to transplantation. Liver Transpl 15:1696–1702, 2009. © 2009 AASLD.