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| |  Study Examines Liver Transplantation After Drug Induced Acute Liver Failure HOBOKEN, NJ -- July 1, 2009 -- Liver transplantation offers a good chance for survival for patients with drug induced acute liver failure, however, certain pre-transplant factors are associated with worse outcomes. Patients who are on life support, who have elevated serum creatinine, and children whose liver failure was caused by antiepileptic drugs did not fare as well after transplantation, according to a study published in the July issue of Liver Transplantation. Drug induced acute liver failure is very rare, but can be life-threatening. Acetaminophen is the most common cause, accounting for nearly half of cases in adults, but other drugs can also be responsible. For patients who are unlikely to recover spontaneously, liver transplantation is the only treatment. Ayse L. Mindikoglu, MD, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland, examined the United Network for Organ Sharing (UNOS) database which contains information about outcomes of nearly all liver transplants performed in the United States since 1987. They planned to analyse all of the drugs associated with acute liver failure and subsequent liver transplantation, determine survival rates after transplantation, and develop a model that would predict the risk of death after transplantation for these patients. They included 661 patients (567 adults and 94 children) who were transplanted for drug induced acute liver failure between October 1, 1987 and December 31, 2006. For each case, they collected 20 recipient and 6 donor demographic and clinical variables from the database. They found that the leading drug groups causing liver failure that required transplantation were acetaminophen (40%), antituberculosis drugs (8%), antiepileptics (7%), and antibiotics (6%). For the entire cohort of transplant recipients, median survival time was 14.4 years. One year estimated survival probabilities were 76%, 82%, 52%, 82%, and 79% for acetaminophen, antituberculosis, antiepileptics, antibiotics and others, respectively. “Among the patients who had acute liver failure due to antiepileptics, 1-year survival was only 27% in patients aged less than 18 years compared with 75% in patients aged 18 years or older,” the authors wrote. Interestingly, these patients were least likely to be listed as status 1 and spent the most time waiting for an organ. Also, the warm and cold ischaemia times were longest for this group of patients. “The relatively low survival probability persisted after controlling for these variables in multivariate analysis,” the authors reported. The reasons for the decreased survival in this group could not be elucidated based on the available data. Examining the different demographic and clinical factors for each patient and donor, the researchers noted that, “elevated serum creatinine, being on life support, and drug-induced acute liver failure due to antiepileptics (aged <18 years) were found to be independent pretransplant predictors of poor survival.” SOURCE: Wiley-Blackwell
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