title: The utilization of liver transplantation in the management of acute liver failure: comparison between acetaminophen and non-acetaminophen etiologies.
abstract: Liver transplantation (LT) may be life-saving in severe acute liver failure (ALF). The aim of this study was to compare the utilization of LT in acetaminophen and non-acetaminophen ALF. Between 1992 and 2006, 469 patients with ALF were admitted, and 104 underwent LT. Acetaminophen was the most common etiology, but LT proceeded more frequently in the non-acetaminophen cohort (acetaminophen: 45/326 patients received LT, 13.8%; non-acetaminophen: 59/143 patients received LT, 41.3%; P < 0.01). A retrospective analysis of the individual steps in the management of patients revealed more ALF patients in the non-acetaminophen cohort fulfilled the King's College Hospital poor prognostic criteria (non-acetaminophen: 91/143, 63.6%; acetaminophen: 165/326, 50.6%; P < 0.01), more patients had contraindications to LT in the acetaminophen cohort (acetaminophen: 99/165, 60%; non-acetaminophen: 21/91, 23.1%; P < 0.01), and survival on the LT waiting list was reduced in the acetaminophen cohort (acetaminophen: 45/66, 68.2%; non-acetaminophen: 59/70, 84.3%; P < 0.05). Post-LT survival was similar in the 2 groups. An analysis of cohorts admitted in 1993-1996 and 2002-2005 revealed that LT proceeded less commonly in acetaminophen ALF in the later cohort (1993-1996: 16/99 LT, 16.2%; 2002-2005: 4/81 LT, 5%; P < 0.01) in comparison with the non-acetaminophen cohort, in which transplantation proceeded more commonly in the later cohort (1993-1996: 11/34 LT, 32.4%; 2002-2005: 24/49 patients, 49.0%; P < 0.01). This was due to an increase in the number of patients with psychiatric contraindications to transplantation (predominantly resistant and severe alcohol dependence). In conclusion, at all decision steps between admission and emergency LT, LT is favored in non-acetaminophen patients, and nonoperative management is favored in acetaminophen ALF patients.
authors.affiliation: Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. k.simpson@ed.ac.uk
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Simpson
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Bates
authors.forename: Neil C
authors.initials: NC
authors.lastname: Henderson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wigmore
authors.forename: O James
authors.initials: OJ
authors.lastname: Garden
authors.forename: Alistair
authors.initials: A
authors.lastname: Lee
authors.forename: Antony
authors.initials: A
authors.lastname: Pollok
authors.forename: George
authors.initials: G
authors.lastname: Masterton
authors.forename: Peter C
authors.initials: PC
authors.lastname: Hayes
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D015331:Cohort Studies; D000075202:Contraindications; D062787:Drug Overdose / Q000150:complications; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D012606:Scotland; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen