Citation

Karvellas CJ, Safinia N, Auzinger G, Heaton N, Muiesan P, O'Grady J, Wendon J, Bernal W. Liver Int. 2010; 30(6): 826-833.

Copyright

(Copyright © 2010, John Wiley and Sons)

DOI

10.1111/j.1478-3231.2010.02243.x

PMID

unavailable

Abstract

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. © 2010 John Wiley & Sons A/S.

Language: en

Keywords

Humans; Risk Factors; Adult; Female; Male; adult; human; Severity of Illness Index; Suicide; female; male; Retrospective Studies; Risk Assessment; Time Factors; Treatment Outcome; Chi-Square Distribution; Kaplan-Meier Estimate; Suicide, Attempted; United Kingdom; liver failure; Case-Control Studies; cause of death; mortality; suicide attempt; complication; Acetaminophen; risk assessment; treatment outcome; liver transplantation; psychology; Reoperation; risk factor; article; major clinical study; mental disease; controlled study; analgesic agent; retrospective study; graft rejection; self poisoning; paracetamol; Great Britain; Mental Disorders; follow up; patient compliance; psychosocial environment; liver toxicity; case control study; time; Liver transplantation; postoperative complication; graft survival; outcome assessment; Analgesics, Non-Narcotic; chi square distribution; Kaplan Meier method; chemically induced; reoperation; APACHE; Graft Rejection; Liver Failure, Acute; Liver Transplantation; Medication Adherence; Drug-Induced Liver Injury; Acute liver failure; severity of illness index; liver graft rejection; Graft Survival; medication compliance