INTRODUCTION

Before 1986, only a few cases of liver transplantation for acute liver failure (ALF) had been reported (Le Bihan et al. 1982; Williams and Gimson 1984; Iwatzuki et al. 1985; Ringe et al. 1986). By 1988, 85 cases of transplantation for ALF had been listed (European Liver Transplant Registry 1995). The reasons for the low number of successful cases reported were multiple: the indications of liver transplantation as well as the timing of transplantation were not clearly denned; national organizations for organ sharing were not well organized for emergency liver procurement; and there were many technical limitations, such as the inability to correct coagulation defects or to perform transplantation in patients with multiple organ failure (associated anuria, sepsis, etc.). Our center was one of the first in the world to start a program of emergency liver transplantation for ALF, beginning in January 1986. The initial experience with 17 patients transplanted for ALF was reported one year later (Bismuth et al. 1987).

Since then, there has been a dramatic increase in the number of transplants performed in the world for ALF. Between 1988 and 1993, 1390 patients with acute liver failure were transplanted in Europe, representing 12 percent of the primary indications for liver transplantation (European Liver Transplant Registry 1995). Among these 1390 patients, 982 were reported to have fulminant hepatitis, 70 subfulminant hepatitis and 338 acute liver failure of other causes.