Fulminant hepatic failure (FHF) is an acute, catastrophic, rapidly fatal illness that results in severe hepatocyte damage or massive necrosis.<sup>46 McCaul T.F., Fagan E.A., Tovey G. , y al. Fulminant hepatitis: An ultrastructural study J Hepatology 1986 ;  369 : 276-290  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> Acute liver damage is sufficient to cause the rapid onset of encephalopathy and coagulopathy followed by multi-organ failure. Unlike progressive liver failure from underlying cirrhosis, FHF occurs in previously healthy individuals and carries an 80% mortality rate without liver transplantation. Approximately 2000 cases of FHF are reported annually in the United States, with no identifiable cause found in up to 50% of these cases.<sup>18 Detre K., Belle S., Beringer K. , y al. Liver transplantation for fulminant hepatic failure in the United States: October 1987 through December 1991 Clin Transpl 1994 ;  8 : 274-280

Haga clic aquí para ir a la sección de Referencias</sup> The clinical manifestations of this disorder are varied, and treatment is primarily supportive.

Fulminant hepatic failure usually is defined as either acute liver disease occurring in the absence of preexisting liver disease leading to encephalopathy within 8 weeks of the onset of symptoms<sup>77 Trey C., Davidson C.S. The management of fulminant hepatic disease Progress in Liver Disease, vol 3 New York: Grune & Stratton (1970).  282-298

Haga clic aquí para ir a la sección de Referencias</sup> or liver disease leading to encephalopathy within 2 weeks of the onset of jaundice.<sup>7 Bernuau J., Rueff B., Benhamou J.P. Fulminant and sub-fulminant liver failure: Definitions and causes Semin Liver Dis 1986 ;  6 : 97-106  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> A new classification of fulminant hepatic failure has been proposed based on the interval from the onset of jaundice to the development of encephalopathy.<sup>59 O'Grady J.G., Williams R.G. Acute liver failure: Redefining the syndromes Lancet 1993 ;  342 : 273-275

Haga clic aquí para ir a la sección de Referencias</sup> This new classification provides a better determination of etiology and estimate of prognosis than did previous definitions. Three subgroups of fulminant hepatic failure have been defined as: (1) hyperacute, (2) acute, and (3) subacute.<sup>59 O'Grady J.G., Williams R.G. Acute liver failure: Redefining the syndromes Lancet 1993 ;  342 : 273-275

Haga clic aquí para ir a la sección de Referencias</sup> Hyperacute liver failure is encephalopathy that develops within 8 days of the onset of jaundice. The most common etiology is acetaminophen overdose. Occasionally, hepatitis A or B may present in this fashion. Acute liver failure is defined as the onset of encephalopathy 8 to 28 days after the development of jaundice. Viral hepatitis and idiosyncratic drug reactions make up the majority of cases that present in this fashion. Subacute liver failure is defined as the development of encephalopathy 4 to 26 weeks after the onset of jaundice.<sup>27 Gimson A.E., O'Grady J., Ede R.J. , y al. Late onset hepatic failure: Clinical, serological and histological features Hepatology 1986 ;  6 : 288-294  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> Patients with non-A non-B non-C hepatitis represent most of these cases. Patients with hyperacute liver failure have a reported survival rate of 36% without liver transplantation; the survival rate of patients with acute and subacute liver failure is reported at 7% and 14%, respectively.<sup>55 O'Grady J.G., Alexander G.J.M., Thick M. , y al. Outcome of orthotopic liver transplantation in the aetiological and clinical variants of acute liver failure QJ Med 1988 ;  69 : 817-824

Haga clic aquí para ir a la sección de Referencias, 59 O'Grady J.G., Williams R.G. Acute liver failure: Redefining the syndromes Lancet 1993 ;  342 : 273-275

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