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Etiology and outcome for 295 patients with acute liver failure in the united states

  1. Frank V. Schiødt,
  2. Evren Atillasoy,
  3. A. Obaid Shakil,
  4. Eugene R. Schiff,
  5. Cary Caldwell,
  6. Kris V. Kowdley,
  7. Risë Stribling,
  8. Jeffrey S. Crippin,
  9. Steven Flamm,
  10. Kenneth A. Somberg,
  11. Hugo Rosen,
  12. Tim M. McCashland,
  13. J. Eileen Hay,
  14. William M. Lee*,
  15. the Acute Liver Failure Study Group

Article first published online: 30 DEC 2003

DOI: 10.1002/lt.500050102

Issue

Liver Transplantation and Surgery

Liver Transplantation and Surgery

Volume 5, Issue 1, pages 29–34, January 1999

Additional Information

How to Cite

Schiødt, F. V., Atillasoy, E., Shakil, A. O., Schiff, E. R., Caldwell, C., Kowdley, K. V., Stribling, R., Crippin, J. S., Flamm, S., Somberg, K. A., Rosen, H., McCashland, T. M., Hay, J. E., Lee, W. M. and the Acute Liver Failure Study Group (1999), Etiology and outcome for 295 patients with acute liver failure in the united states. Liver Transpl, 5: 29–34. doi: 10.1002/lt.500050102

Author Information

  1. University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver Centers

*Address reprint requests to William M. Lee, MD, Liver Unit, UT Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75235-9151

Publication History

  1. Issue published online: 30 DEC 2003
  2. Article first published online: 30 DEC 2003

Funded by

  • Danish Medical Research Council Copenhagen. Grant Number: 9400630
  • Jeppe Juhl and wife Ovita Juhl Foundation (F.V.S.)
  • Alison B. Harwood, Charleston, SC; Mr and Mrs W.H. Pickens, Dallas, TX
  • National Institutes of Health, Bethesda, MD. Grant Number: R-O3 DK52827-01

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Abstract

Little information is available on acute liver failure (ALF) in the United States. We gathered demographic data retrospectively for a 2-year period from July 1994 to June 1996 on all cases of ALF from 13 hospitals (12 liver transplant centers). Data on the patients included age, hepatic coma grade on admission, presumed cause, transplantation, and outcome. Among 295 patients, 74 (25%) survived spontaneously, 121 (41%) underwent transplantation, and 99 (34%) died without undergoing transplantation. Ninety-two of 121 patients (76%) survived 1 year after transplantation. Acetaminophen overdose was the most frequent cause (60 patients; 20%), followed by cryptogenic/non A non B non C (NANBNC; 15%), idiosyncratic drug reactions (12%), hepatitis B (10%), and hepatitis A (7%). Spontaneous survival rates were highest for patients with acetaminophen overdose (57%) and hepatitis A (40%) and lowest for those with Wilson's disease (no survivors of 18 patients). The transplantation rate was highest for Wilson's disease (17 of 18 patients; 94%) and lowest for autoimmune hepatitis (29%) and acetaminophen overdose (12%). Age did not differ between survivors and nonsurvivors, perhaps reflecting a selection bias for patients transferred to liver transplant centers. Coma grade on admission was not a significant determinant of outcome, but showed a trend toward affecting both survival and transplantation rate. These findings on retrospectively studied patients from the United States differ from those previously gathered in the United Kingdom and France, highlighting the need for further study of trends in each country.

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