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Long-term outcome in patients with acute liver failure

Putignano, A; Figorilli, F; Alabsawy, E; Agarwal, B; Jalan, R; (2018) Long-term outcome in patients with acute liver failure. Liver International 10.1111/liv.13914. (In press). Green open access

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Abstract

BACKGROUND AND 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 center study, we aimed to confirm or refute this observation. METHODS: Early survivors (patients who survived 90 days) were assessed for long term outcomes in 4 distinctive cohorts, incorporating aetiology (Acetaminophen overdose or non-Acetaminophen overdose related acute liver failure), and management strategy (conservative or liver transplantation). Chi Squared or Fisher test were used to compare outcomes among the 4 cohorts (p<0.05) and Kaplan Meier curve (Log Rank test) to represent cumulative survival. RESULTS: 200 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. 11/124 (8.9%) died subsequently (median survival 5.3 ± IQR 9.1); three spontaneous survivors and 8 transplanted patients (p=0.025); of the 8 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 operation 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. This article is protected by copyright. All rights reserved.

Type: Article
Title: Long-term outcome in patients with acute liver failure
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/liv.13914
Publisher version: https://doi.org/10.1111/liv.13914
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Acetaminophen Overdose, Early Deaths, Early Survivors, Emergency Liver Transplantation, Spontaneous Survivors
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: http://discovery.ucl.ac.uk/id/eprint/10052704
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