title: Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study.
abstract: OBJECTIVE
  The long-term clinical outcomes in initial survivors with acute liver failure (ALF) are not well known. The aim of this study was to provide an overview of the 2-year clinical outcomes among initial survivors and liver transplant (LT) recipients that were alive 3 weeks after enrolment in the Acute Liver Failure Study Group (ALFSG).
  
  
  METHODS
  Outcomes in adult ALFSG patients that were enrolled between 1998 and 2010 were reviewed.
  
  
  RESULTS
  Two-year patient survival was significantly higher in the 262 LT recipients (92.4%) compared to the 306 acetaminophen (APAP) spontaneous survivors (SS) (89.5%) and 200 non-APAP SS (75.5%) (P < 0.0001). The causes of death were similar in the three groups but the time to death was significantly longer in the LT recipients (P < 0.0001). Independent predictors of 2-year mortality in the APAP group were a high serum phosphate level and patient age (c-statistic = 0.65 (0.54, 0.76)), patient age and days from jaundice to ALF onset in the non-APAP group (c-statistic = 0.69 (0.60, 0.78)), and patient age, days from jaundice, and higher coma grade in the LT recipients (c-statistic = 0.74 (0.61, 0.87)). The LT recipients were significantly more likely to be employed and have a higher educational level (P < 0.05).
  
  
  CONCLUSIONS
  Two-year outcomes in initial survivors of ALF are generally good but non-APAP patients have a significantly lower survival which may relate to pre-existing medical comorbidities. Spontaneous survivors with APAP overdose experience substantial morbidity during follow-up from ongoing psychiatric and substance abuse issues.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, 48109-0362, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.forename: Caitlyn
authors.initials: C
authors.lastname: Ellerbe
authors.forename: Valerie E
authors.initials: VE
authors.lastname: Durkalski
authors.forename: Amol
authors.initials: A
authors.lastname: Rangnekar
authors.forename: Rajender K
authors.initials: RK
authors.lastname: Reddy
authors.forename: Todd
authors.initials: T
authors.lastname: Stravitz
authors.forename: Brendan
authors.initials: B
authors.lastname: McGuire
authors.forename: Timothy
authors.initials: T
authors.lastname: Davern
authors.forename: Adrian
authors.initials: A
authors.lastname: Reuben
authors.forename: Iris
authors.initials: I
authors.lastname: Liou
authors.forename: Oren
authors.initials: O
authors.lastname: Fix
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Ganger
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Chung
authors.forename: Mike
authors.initials: M
authors.lastname: Schilsky
authors.forename: Steven
authors.initials: S
authors.lastname: Han
authors.forename: Linda S
authors.initials: LS
authors.lastname: Hynan
authors.forename: Corron
authors.initials: C
authors.lastname: Sanders
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017114:Liver Failure, Acute / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D017741:Survivors / Q000706:statistics & numerical data*; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D000082:Acetaminophen
keywords: age; cerebral oedema; liver transplantation; prognosis; regeneration