TY - JOUR
T1 - Outcomes of liver transplantation for paracetamol (acetaminophen)-induced hepatic failure.
AU - Cooper, Sheldon
AU - Aldridge, RC
AU - Shah, Tahir
AU - Webb, K
AU - Nightingale, Peter
AU - Paris, S
AU - Gunson, Bridget
AU - Mutimer, David
AU - Neuberger, James
PY - 2009/10/1
Y1 - 2009/10/1
N2 - Paracetamol (acetaminophen) hepatotoxicity, whether due to intentional overdose or therapeutic misadventure, is an indication for liver transplantation in selected cases. However, there is a concern that long-term outcomes may be compromised by associated psychopathology that may predispose patients to further episodes of self-harm or poor treatment adherence. We therefore undertook a retrospective analysis of patients transplanted for paracetamol-induced fulminant hepatic failure (FHF) to determine their long-term outcomes, psychiatric problems, and compliance and whether these issues could be predicted from pretransplant information. Records from patients undergoing liver transplantation for paracetamol-associated liver failure in this unit and 2 comparison groups (patients undergoing liver replacement for FHF from other causes and for chronic liver diseases) were examined. Of 60 patients transplanted for paracetamol-induced FHF between 1989 and 2007, 44 (73%) survived to discharge. Currently, 35 patients (58%) are surviving at an average of 9 years post-transplantation. The incidence of psychiatric disease (principally depression) and 30-day mortality were greatest in the paracetamol group, but for those who survived 30 days, there was no difference in long-term survival rates between the groups. Adherence to follow-up appointments and compliance with immunosuppression were lowest in the paracetamol overdose group. Poor adherence was not predicted by any identifiable premorbid psychiatric conditions. Two patients grafted for paracetamol FHF died from self-harm (1 from suicide and 1 from alcoholic liver disease after 5 years). This study suggests that, notwithstanding the shortage of donor liver grafts, transplantation is an appropriate therapy in selected patients, although close follow-up is indicated.
AB - Paracetamol (acetaminophen) hepatotoxicity, whether due to intentional overdose or therapeutic misadventure, is an indication for liver transplantation in selected cases. However, there is a concern that long-term outcomes may be compromised by associated psychopathology that may predispose patients to further episodes of self-harm or poor treatment adherence. We therefore undertook a retrospective analysis of patients transplanted for paracetamol-induced fulminant hepatic failure (FHF) to determine their long-term outcomes, psychiatric problems, and compliance and whether these issues could be predicted from pretransplant information. Records from patients undergoing liver transplantation for paracetamol-associated liver failure in this unit and 2 comparison groups (patients undergoing liver replacement for FHF from other causes and for chronic liver diseases) were examined. Of 60 patients transplanted for paracetamol-induced FHF between 1989 and 2007, 44 (73%) survived to discharge. Currently, 35 patients (58%) are surviving at an average of 9 years post-transplantation. The incidence of psychiatric disease (principally depression) and 30-day mortality were greatest in the paracetamol group, but for those who survived 30 days, there was no difference in long-term survival rates between the groups. Adherence to follow-up appointments and compliance with immunosuppression were lowest in the paracetamol overdose group. Poor adherence was not predicted by any identifiable premorbid psychiatric conditions. Two patients grafted for paracetamol FHF died from self-harm (1 from suicide and 1 from alcoholic liver disease after 5 years). This study suggests that, notwithstanding the shortage of donor liver grafts, transplantation is an appropriate therapy in selected patients, although close follow-up is indicated.
U2 - 10.1002/lt.21799
DO - 10.1002/lt.21799
M3 - Article
C2 - 19790165
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
SN - 1527-6473
VL - 15
SP - 1351
EP - 1357
JO - Liver Transplantation
JF - Liver Transplantation
IS - 10
ER -