Medical and psychiatric outcomes for patients transplanted for acetaminophen-induced acute liver failure: a case–control study
Article first published online: 8 APR 2010
© 2010 John Wiley & Sons A/S
Volume 30, Issue 6, pages 826–833, July 2010
How to Cite
Karvellas, C. J., Safinia, N., Auzinger, G., Heaton, N., Muiesan, P., O'Grady, J., Wendon, J. and Bernal, W. (2010), Medical and psychiatric outcomes for patients transplanted for acetaminophen-induced acute liver failure: a case–control study. Liver International, 30: 826–833. doi: 10.1111/j.1478-3231.2010.02243.x
- Issue published online: 31 MAY 2010
- Article first published online: 8 APR 2010
- Received 25 November 2009Accepted 24 February 2010
- acute liver failure;
- liver transplantation;
Background: Acetaminophen-induced hepatotoxicity is the most common cause of acute liver failure (ALF) in the UK. Patients often consume the drug with suicidal intent or with a background of substance dependence.
Aims and methods: We compared the severity of pretransplant illness, psychiatric co-morbidity, medical and psychosocial outcomes of all patients who had undergone liver transplantation (LT) emergently between 1999–2004 for acetaminophen-induced ALF (n=36) with age- and sex-matched patients undergoing emergent LT for non-acetaminophen-induced ALF (n=35) and elective LT for chronic liver disease (CLD, n=34).
Results: Acetaminophen-induced ALF patients undergoing LT had a greater severity of pre-LT illness reflected by higher Acute Physiology and Chronic Health Evaluation II scores and requirement for organ support compared with the other two groups. Twenty (56%) acetaminophen-induced ALF patients had a formal psychiatric diagnosis before LT (non-acetaminophen-induced ALF=0/35, CLD=2/34; P<0.01 for all) and nine (25%) had a previous suicide attempt. During follow-up (median 5 years), there were no significant differences in rejection (acute and chronic), graft failure or survival between the groups (acetaminophen-induced ALF 1 year 87%, 5 years 75%; non-acetaminophen-induced ALF 88%, 78%; CLD 93%, 82%: P>0.6 log rank). Two acetaminophen-induced ALF patients reattempted suicide post-LT (one died 8 years post-LT).
Conclusions: Despite a high prevalence of psychiatric disturbance, outcomes for patients transplanted emergently for acetaminophen-induced ALF were comparable to those transplanted for non-acetaminophen-induced ALF and electively for CLD. Multidisciplinary approaches with long-term psychiatric follow-up may contribute to low post-transplant suicide rates seen and low rates of graft loss because of non-compliance.