Recovery from Fulminant Hepatic Failure and Prolonged Deep Coma without Liver Transplantation

The overall mortality of fulminant hepatic failure without liver transplantation is around 70%. However, the most critical problem in the management of fulminant hepatic failure is the indication of liver transplantation because this disease is sometimes reversible without such treatment. We encountered a 27-year old patient with acute type fulminant hepatic failure and deep coma (grade V hepatic encephalopathy). Electroencephalography showed generalized low voltage activity in all leads, but cranial computed tomography revealed no diffuse brain edema. The patient was treated with artificial liver support without liver transplantation, and finally recovered without any neurological deficits. The indications for liver transplantation in patients with deep coma are still controversial because the reversibility of severe coma cannot be accurately predicted before the transplantation. Therefore, more data are needed for the correct therapeutic management (with or without liver transplantation) of fulminant hepatic failure