ABSTRACT
Acetam inophen toxicity m ay cause massive hepatocellular necrosis leading to fu lm inant hepatic failure (FH F).1,2 In acetam inophen-induced FHF patients, prognosis can be accurately assessed using criteria defined by the King s College H ospital (KCH) group.3 According to these widely accepted and validated criteria, in the absence o f o rtho top ic liver transp lan ta tion (OLT) the probability o f patien t death is 90% if:
1. The arterial b lood pH is less than 7.3 at 24 hours o r later after acetam inophen ingestion, assum ing appropriate volum e loading; o r
2. A serum creatinine level greater than 300 pm ol/l, hepatic encephalopathy grade o f III-IV and an in ternational norm alized ratio (INR) greater than 7 are concurrently present.4' 7
OLT rem ains the only definitive treatm ent for FHF patients who fulfill the above criteria. H ow ever, access to OLT is lim ited by o rg an d o n o r sho rtag e , p sy ch ia tric an d o th e r contraindications as well as high cost and significant associated m orbidity.5,8 In ou r institution, we have developed a trea tm en t strategy based on the use o f an extracorporeal bioartificial liver (BAL) suppo rt system.9 In this section, we describe the successful clinical application o f BAL su ppo rt to trea t patients w ith acetam inophen-induced FHF.
