Emergency liver transplantation for acute liver failure

Pauwels, Arnaud; Mostefa-Kara, Nassim; Florent, C; Lévy, V. G.

doi:10.1016/s0168-8278(05)80532-x

Cited by 200 publications

(112 citation statements)

References 11 publications

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“…Clearly, improved prognostic criteria are needed. 22,39,40 In conclusion, acetaminophen poisoning now accounts for at least 42% of U.S. acute liver failure cases seen at tertiary-care centers and one third of the deaths. Unintentional overdose is the leading form of acetaminophen hepatotoxicity in U.S. ALF subjects, but suicidal ingestions remain important as well.…”

Section: Discussionmentioning

confidence: 97%

“…4,6,13,24,[34][35][36] The overall transplant-free survival rate of 65% in acetaminophen subjects is comparable to that of prior studies and continues to be more favorable than that observed for most other ALF causes. 13,37,38,39 The use of the King's criteria at admission to predict outcome was inaccurate, and use of the APACHE II provided a more accurate of assessment outcome. Clearly, improved prognostic criteria are needed.…”

Section: Discussionmentioning

confidence: 99%

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Acetaminophen-induced acute liver failure: Results of a United States multicenter, prospective study

et al. 2005

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Severe acetaminophen hepatotoxicity frequently leads to acute liver failure (ALF). We determined the incidence, risk factors, and outcomes of acetaminophen-induced ALF at 22 tertiary care centers in the United States. Detailed prospective data were gathered on 662 consecutive patients over a 6-year period fulfilling standard criteria for ALF (coagulopathy and encephalopathy), from which 275 (42%) were determined to result from acetaminophen liver injury. The annual percentage of acetaminophen-related ALF rose during the study from 28% in 1998 to 51% in 2003. Median dose ingested was 24 g (equivalent to 48 extra-strength tablets). Unintentional overdoses accounted for 131 (48%) cases, intentional (suicide attempts) 122 (44%), and 22 (8%) were of unknown intent. In the unintentional group, 38% took two or more acetaminophen preparations simultaneously, and 63% used narcotic-containing compounds. Eighty-one percent of unintentional patients reported taking acetaminophen and/or other analgesics for acute or chronic pain syndromes. Overall, 178 subjects (65%) survived, 74 (27%) died without transplantation, and 23 subjects (8%) underwent liver transplantation; 71% were alive at 3 weeks. Transplant-free survival rate and rate of liver transplantation were similar between intentional and unintentional groups. In conclusion, acetaminophen hepatotoxicity far exceeds other causes of acute liver failure in the United States. Susceptible patients have concomitant depression, chronic pain, alcohol or narcotic use, and/or take several preparations simultaneously. Education of patients, physicians, and pharmacies to limit high-risk use settings is recommended. (HEPATOLOGY 2005;42:1364-1372

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Acetaminophen-induced acute liver failure: Results of a United States multicenter, prospective study

et al. 2005

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“…Among several selection criteria for urgent liver transplantation, the King's College Hospital (KCH) criteria have gained considerable acceptance. [3][4][5][6][7][8][9][10] However, shortcomings of the KCH criteria have been a limited sensitivity and a late identification of the patients who require transplantation. 11 It has therefore been of interest to discover prognostic indicators with the capability of identifying transplant candidates at an earlier stage of liver failure, perhaps even prior to the onset of hepatic encephalopathy (HE).…”

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confidence: 99%

MELD score as a predictor of liver failure and death in patients with acetaminophen-induced liver injury

2007

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The Model for End-Stage Liver Disease (MELD) scoring system has been established as a reliable measure of short-term mortality risk in patients with end-stage chronic liver disease. The aim of this study was to evaluate the prognostic value of the MELD scoring as a predictor of fulminant hepatic failure (FHF) and death in patients with acetaminophen poisoning. Prospectively, serial measurements of the 3 MELD components-INR, bilirubin, and creatinine-were performed in 460 patients with acetaminophen-induced liver injury. Starting on the first day after the day of overdose, MELD score was significantly higher in patients who eventually developed hepatic encephalopathy (HE) than in those who did not. HE developed in 63 of 142 patients with a MELD score above 18 at 48-72 hours after the overdose (positive predictive value 44%) compared with 2 of 182 patients with a MELD score of 18 or below (negative predictive value 99%). Among 124 patients with FHF, a threshold MELD score of 33 on the day after the onset of HE had sensitivity of 60%, specificity of 69%, positive predictive value of 65%, and negative predictive value of 63%. However, the discriminative power of

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“…The King's College prognostic criteria have been adopted by most centers, 11 although they fail to identify patients at low risk of dying. 12 Alternatives to whole organ transplantation for liver dysfunction are under active investigation. Figure 1 schematically depicts the 4 main cellular approaches that are currently being investigated: isolated cell transplantation, [13][14][15][16][17] tissue engineering of implantable constructs, [18][19][20][21][22][23][24][25][26][27] transgenic xenotransplantation, [28][29][30][31] and extracorporeal bioartificial liver devices (BAL).…”

mentioning

confidence: 99%