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Objectives and Methods: Despite liver transplantation and advances in intensive care medicine fulminant hepatic failure [FHF] remains a life-threatening condition. Actual observations of the clinical course of these patients are rare. Therefore, we analyzed course of disease and survival in all patients treated for FHF at the University of Bonn between 1998 and 2004 and compared it to the patients treated for FHF during 1992-1997., Results: 35 patients were treated for FHF during this period. FHF was viral induced in 13 patients (HBV n = 11, HAV n = 2), toxic in nine, cryptogenic in eleven and autoimmune and hyperthermia in one patient each. According to London- and/or Clichy criteria 16 patients were transplanted. Four of them died during the first year after transplantation due to infectious and hemorrhagic complications. Three patients died without liver-transplantation. All together, 1-year survival was 80%. When compared to patients with FHF analyzed in the period 1992-1997 numbers of patients with FHF in our centre had increased from 16 to 35 patients and 1-year survival improved from 67.5% to 80%. This improved survival was associated with a lower proportion of transplanted patients (45% versus 68%)., Conclusions: These changes reflect advances in therapy of patients with FHF, which enables a greater proportion of patients to survive without the need for transplantation.