Fontana, Robert J2; Ellerbe, Caitlyn2; Durkalski, Valerie E2; Rangnekar, Amol2; Reddy, Rajender K2; Stravitz, Todd2; McGuire, Brendan2; Davern, Timothy2; Reuben, Adrian2; Liou, Iris2; Fix, Oren2; Ganger, Daniel R2; Chung, Raymond T2; Schilsky, Mike2; Han, Steven2; Hynan, Linda S2; Sanders, Corron2; Lee, William M2; Schiødt, Frank Vinholt3
1 Digestive Diease Center, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark2 unknown3 Endokrinologisk Afdeling I, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark
results from a prospective, multicentre study
BACKGROUND & AIMS: 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.
Liver International : Official Journal of the International Association for the Study of the Liver, 2015, Vol 35, Issue 2, p. 370-80