title: Transplantation for acute liver failure in patients exposed to NSAIDs or paracetamol (acetaminophen): the multinational case-population SALT study.
abstract: BACKGROUND
  Most NSAIDs are thought to be able to cause hepatic injury and acute liver failure (ALF), but the event rates of those leading to transplantation (ALFT) remain uncertain.
  
  
  OBJECTIVE
  The aim of the study was to estimate population event rates for NSAID-associated ALFT METHODS: This was a case-population study of ALFT in 57 eligible liver transplant centres in seven countries (France, Greece, Ireland, Italy, The Netherlands, Portugal and the UK). Cases were all adults registered from 2005 to 2007 for a liver transplant following ALFT without identified clinical aetiology, exposed to an NSAID or paracetamol (acetaminophen) within 30 days before the onset of clinical symptoms. NSAID and paracetamol population exposures were assessed using national sales data from Intercontinental Marketing Services (IMS). Risk was estimated as the rate of ALFT per million treatment-years (MTY).
  
  
  RESULTS
  In the 52 participating centres, 9479 patients were registered for transplantation, with 600 for ALFT, 301 of whom, without clinical aetiology, had been exposed to a drug within 30 days. Of these 301 patients, 40 had been exposed to an NSAID and 192 to paracetamol (81 of whom were without overdose). Event rates per MTY were 1.59 (95 % CI 1.1-2.2) for all NSAIDs pooled, 2.3 (95 % CI 1.2-3.9) for ibuprofen, 1.9 (95 % CI 0.8-3.7) for nimesulide, 1.6 (95 % CI 0.6-3.4) for diclofenac and 1.6 (95 % CI 0.3-4.5) for ketoprofen. For paracetamol, the event rate was 3.3 per MTY (95 % CI 2.6-4.1) without overdoses and 7.8 (95 % CI 6.8-9.0) including overdoses.
  
  
  CONCLUSIONS
  ALF leading to registration for transplantation after exposure to an NSAID was rare, with no major difference between NSAID. Non-overdose paracetamol-exposed liver failure was twice more common than NSAID-exposed liver failure.
authors: INSERM CIC-P0005 Pharmaco-épidémiologie, INSERM U657, Service de Pharmacologie, Université Bordeaux Segalen, Bâtiment Le Tondu, Case 41, 146, Rue Léo Saignat, 33076 Bordeaux Cedex, France. sinemezgi.gulmez@u-bordeaux2.fr
authors: Sinem Ezgi
authors: SE
authors: Gulmez
authors: Dominique
authors: D
authors: Larrey
authors: Georges-Philippe
authors: GP
authors: Pageaux
authors: Severine
authors: S
authors: Lignot
authors: Régis
authors: R
authors: Lassalle
authors: Jérémy
authors: J
authors: Jové
authors: Angelo
authors: A
authors: Gatta
authors: P Aiden
authors: PA
authors: McCormick
authors: Harold J
authors: HJ
authors: Metselaar
authors: Estela
authors: E
authors: Monteiro
authors: Douglas
authors: D
authors: Thorburn
authors: William
authors: W
authors: Bernal
authors: Irene
authors: I
authors: Zouboulis-Vafiadis
authors: Corinne
authors: C
authors: de Vries
authors: Susana
authors: S
authors: Perez-Gutthann
authors: Miriam
authors: M
authors: Sturkenboom
authors: Jacques
authors: J
authors: Bénichou
authors: Jean-Louis
authors: JL
authors: Montastruc
authors: Yves
authors: Y
authors: Horsmans
authors: Francesco
authors: F
authors: Salvo
authors: Fatima
authors: F
authors: Hamoud
authors: Sophie
authors: S
authors: Micon
authors: Cécile
authors: C
authors: Droz-Perroteau
authors: Patrick
authors: P
authors: Blin
authors: Nicholas
authors: N
authors: Moore
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen