Introduction: To analyze the current results of transplantation in acute liver failure at the Istanbul Faculty of Medicine.

Materials and Methods: The charts of the 26 patients (8 males, 18 females; median (range) age: 15(2-62) years) who underwent liver transplantation for acute liver failure between 2008-2012 were evaluated retrospectively.

Results: The identified etiologic factors were : toxic agents (6; mushrooms 5, herbal tea 1), Wilson’s disease (4), autoimmune hepatitis (3), fulminant Budd-Chiari syndrome (2), acute hepatitis B infection (2), acute hepatitis A infection (1); 8 cases were cryptogenic. Organs from cadaveric donors were transplanted to 20 patients (3 left lateral sections from split livers); 6 patients underwent living donor transplantation (3 right lobes and 3 left lateral sections). One patient (4%) died of multiple organ failure, with a functioning graft on the second postoperative day. Bacterial infection was the most common early complication (20/25; 80%), followed by postoperative delirium (3/25; 12%) (treated with short courses of psychotropic agents) and severe acute rejection (2/25; 8%) (treated with pulse steroids). Acute renal failure (required hemodialysis but recovered without sequel), thrombotic thrombocytopenic purpura (treated successfully with plasmapheresis), tracheal stenosis due to prolonged intubation (treated with a removable stent), nonanastomotic hepatic artery stenosis due to kinking (in the second postoperative month; intimal dissection and thrombosis occurred during angioplasty. Recanalization was achieved with medical treatment but an asymptomatic left hepatic duct stricture developed.), recurrent autoimmune hepatitis (in the second postoperative month; treated successfully with modification of the immunosuppressive protocol) and stricture of the choledochocholedochostomy (treated with endoscopic stenting) occurred in one patient each. One patient died on the 18th postoperative month due to a fungal infection precipitated by steroid-resistant rejection treatment. Overall survival was 24/26 (92%).

Conclusions: Improved cadaveric organ sharing, use of split grafts when possible, and transplantation from living donors in appropriate situations yield a high survival rate, despite high early morbidity, in acute liver failure patients whose condition deteriorates despite intensive care treatment.