Acute hepatic failure: University of Toronto experience

Abstract

Fulminant hepatic failure (FHF) is a serious disorder of the liver that is associated with a mortality of 80 to 90%. Admission of patients to specialized liver intensive care units has resulted in an improvement of survival from 10 to 30%. To date, however, no specific medical therapy has proven to be effective, and liver transplantation is the main form of therapy for these patients. Previously, the author demonstrated that prostaglandins could alter: the course of FHF in an experimental animal model caused by the coronavirus, murine hepatitis virus strain 3. Furthermore, in an uncontrolled trial in patients with this disorder, overall survival was 71% in patients treated with intravenous prostaglandins. Based upon these initial results, a prospective randomized controlled trial of intravenous prostaglandin E1 compared with placebo was performed in 41 patients. The overall results showed no improvement in survival of the prostaglandin-treated patients (40%) compared with the controls who were treated with placebo (38%). However, in the patients with FHF caused by acetaminophen, survival was higher in the prostaglandin-treated group (54.5%) compared with the placebo-treated patients (37.5%). Furthermore, if treatment with prostaglandin E1 was initiated within 10 days of first symptoms, survival was 73%, compared with 16% survival if treatment was delayed for more than four days. These results suggest a potential role for prostaglandins in the early management of patients with FHF, especially due to acetaminophen toxicity.