Premium
Long‐term outcome in patients with acute liver failure
Author(s) -
Putignano Antonella,
Figorilli Francesco,
Alabsawy Eman,
Agarwal Banwari,
Jalan Rajiv
Publication year - 2018
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13914
Subject(s) - medicine , liver transplantation , acetaminophen , transplantation , liver failure , log rank test , survival analysis , surgery , anesthesia
Background & Aims Acute liver failure patients who meet poor prognostic criteria have high early mortality without emergency liver transplantation. A recent study however, reported that patients that survive spontaneously have a poorer outcome compared with patients undergoing transplantation. In this single centre study, we aimed to confirm or refute this observation. Methods Early survivors (acute liver failure patients who survived 90 days after the ICU admission) were assessed for long‐term outcomes in four distinctive cohorts, incorporating aetiology (Acetaminophen overdose or non‐Acetaminophen overdose), and management strategy (conservative or liver transplantation). Chi Squared or Fisher test were used to compare outcomes among the four cohorts ( P < 0.05) and Kaplan–Meier curve (Log Rank test) to represent cumulative survival. Results Two hundred consecutive acute liver failure patients between 1990 and 2014 were included; mean age 38.3, ±12.8, male 70, 35%. 124/200 (62%) early survivors were identified; 13/124 (10.5%) acetaminophen patients underwent transplantation and 48/124 (38.7%) survived spontaneously; 36/124 (29.0%) non‐acetaminophen underwent transplantation and 27/124 (21.8%) survived spontaneously. A total of 11/124 (8.9%) died subsequently (median survival 5.3± IQR 9.1), three spontaneous survivors and eight transplanted patients ( P = 0.025); of the eight transplanted patients, six died of transplant related complications and two of suicide. Conclusion The results of this study suggest that although liver transplantation is a life‐saving procedure for acute liver failure patients, they have a worse long‐term outcome compared with spontaneous survivors. Novel therapies to increase the percentage of spontaneous survivors are urgently needed.