Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study
Robert J Fontana, Caitlyn Ellerbe, Valerie E Durkalski, Amol Rangnekar, Rajender K Reddy, Todd Stravitz, Brendan McGuire, Timothy Davern, Adrian Reuben, Iris Liou, Oren Fix, Daniel R Ganger, Raymond T Chung, Mike Schilsky, Steven Han, Linda S Hynan, Corron Sanders, William M Lee, US Acute Liver Failure Study Group, W M Lee, George A Ostapowicz, Frank V Schiødt, Julie Polson, Anne M Larson, Iris Liou, Timothy Davern, Oren Fix, Michael Schilsky, Timothy McCashland, J Eileen Hay, Natalie Murray, A Obaid S Shaikh, Andres Blei, Daniel Ganger, Atif Zaman, Steven H B Han, Robert Fontana, Brendan McGuire, Raymond T Chung, Alastair Smith, Robert Brown, Jeffrey Crippin, Edwin Harrison, Adrian Reuben, Santiago Munoz, Rajender Reddy, R Todd Stravitz, Lorenzo Rossaro, Raj Satyanarayana, Tarek Hassanein, Grace Samuel, Ezmina Lalani, Carla Pezzia, Corron Sanders, Nahid Attar, Joan S Reisch, Linda S Hynan, Janet P Smith, Joe W Webster, Mechelle Murray, Valerie Durkalski, Wenle Zhao, Catherine Dillon, Tomoko Goddard, Robert J Fontana, Caitlyn Ellerbe, Valerie E Durkalski, Amol Rangnekar, Rajender K Reddy, Todd Stravitz, Brendan McGuire, Timothy Davern, Adrian Reuben, Iris Liou, Oren Fix, Daniel R Ganger, Raymond T Chung, Mike Schilsky, Steven Han, Linda S Hynan, Corron Sanders, William M Lee, US Acute Liver Failure Study Group, W M Lee, George A Ostapowicz, Frank V Schiødt, Julie Polson, Anne M Larson, Iris Liou, Timothy Davern, Oren Fix, Michael Schilsky, Timothy McCashland, J Eileen Hay, Natalie Murray, A Obaid S Shaikh, Andres Blei, Daniel Ganger, Atif Zaman, Steven H B Han, Robert Fontana, Brendan McGuire, Raymond T Chung, Alastair Smith, Robert Brown, Jeffrey Crippin, Edwin Harrison, Adrian Reuben, Santiago Munoz, Rajender Reddy, R Todd Stravitz, Lorenzo Rossaro, Raj Satyanarayana, Tarek Hassanein, Grace Samuel, Ezmina Lalani, Carla Pezzia, Corron Sanders, Nahid Attar, Joan S Reisch, Linda S Hynan, Janet P Smith, Joe W Webster, Mechelle Murray, Valerie Durkalski, Wenle Zhao, Catherine Dillon, Tomoko Goddard
Abstract
Background & aims: The long-term clinical outcomes in initial survivors with acute liver failure (ALF) are not well known. The aim of this study was to provide an overview of the 2-year clinical outcomes among initial survivors and liver transplant (LT) recipients that were alive 3 weeks after enrolment in the Acute Liver Failure Study Group (ALFSG).
Methods: Outcomes in adult ALFSG patients that were enrolled between 1998 and 2010 were reviewed.
Results: Two-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 three 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 comorbidities. Spontaneous survivors with APAP overdose experience substantial morbidity during follow-up from ongoing psychiatric and substance abuse issues.
Keywords: age; cerebral oedema; liver transplantation; prognosis; regeneration.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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Source: PubMed