Two‐year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study

Abstract

BACKGROUND The long-term clinical outcomes in initial survivors with acute liver failure (ALF) are not well known. AIMS The aim of the current study is to provide an overview of the 2 year clinical outcomes amongst initial survivors and liver transplant (LT) recipients that were alive 3 weeks after enrollment in the Acute Liver Failure Study Group (ALFSG). METHODS Outcomes in adult ALFSG patients that were enrolled between 1998 and 2010 were reviewed. RESULTS 2-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 3 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 co-morbidities. Spontaneous survivors with APAP overdose experience substantial morbidity during follow-up from ongoing psychiatric and substance abuse issues.

Persistent Liver Biochemistry Abnormalities Are More Common in Older Patients and those With Cholestatic Drug Induced Liver Injury

“…The observed association of persistent liver injury with increasing patient age is not surprising. Studies of ALF patients have demonstrated that older subjects are more likely to die or experience greater morbidity presumably due to impaired hepatic regeneration (14). Older age is a strong determinant of developing chronic hepatitis C virus infection after initial exposure and older patients demonstrate greater evidence of hepatic inflammation and fibrosis progression during follow-up (15, 16).…”

Acetaminophen hepatotoxicity: an updated review

“…With the higher incidence of psychiatric illness and prior suicide attempts in these patients, long-term survival can be affected by repeated suicide attempts, substance abuse, and nonadherence to medications (Cooper et al 2009;Karvellas et al 2010). A review of the Acute Liver Failure Study Group data showed better long-term survival following acetaminophen overdose with transplantation than with spontaneous recovery, possibly due to the need for closer follow up with healthcare professionals after transplantation (Fontana et al 2014). …”

Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in Portugal

“…Overall hospital survival increased from 17% in 1973–1978 to 62% in 2004–2008 at a single center in the UK [3]. In a multicenter registry from the USA, in 1998–2010 ALF 2-year survival has been reported as 92% for LT recipients, 90% for paracetamol-related spontaneous survivors, and 76% for non-paracetamol-related spontaneous survivors [9]. …”