Liver transplant associated with paracetamol overdose: results from the seven‐country SALT study

Patients with psychiatric disorders are usually more exposed to multiple somatic illnesses, including liver diseases. Specific links are established between psychiatric disorders and alcohol hepatitis, hepatitis B, and hepatitis C in the population as a whole, and specifically in drug abusers. Metabolic syndrome criteria, and associated steatosis or non-alcoholic steato-hepatitis (NASH) are frequent in patients with chronic psychiatric disorders under psychotropic drugs, and should be screened. Some psychiatric medications, such as neuroleptics, mood stabilizers, and a few antidepressants, are often associated with drug-induced liver injury (DILI). In patients with advanced chronic liver diseases, the prescription of some specific psychiatric treatments should be avoided. Psychiatric disorders can be a limiting factor in the decision-making and following up for liver transplantation.

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“…The primary cause of these intoxications is acetaminophen (38). Liver toxicity linked to acetaminophen is dose-dependent.…”

Section: Resultsmentioning

confidence: 99%

Liver Illness and Psychiatric Patients

et al. 2016

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“…In the UK and North America, paracetamol overdosage has been the leading cause of ALF [5, 6]. In parts of Europe (e.g., Germany and Portugal), the most common causes of ALF have been non-paracetamol drug-induced liver injury, seronegative (indeterminate) liver injury, and viruses (mostly hepatitis B) [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in Portugal

Simões

Santos

Vicente

et al. 2018

GE Port J Gastroenterol

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Background and Aims: Acute liver failure (ALF) is a rare disease with potentially high mortality rates. We aimed to study the recent epidemiology of ALF in one of the Portuguese liver transplant (LT) regions. Methods: We assessed a retrospective cohort including 34 consecutive patients with ALF admitted to the intensive care unit (ICU) of Curry Cabral Hospital (Lisbon, Portugal) between October 2013 and December 2016. Results: The median age (IQR) was 49 (31–67) years, and 21 (62%) of the cohort were female. Non-paracetamol etiologies were found in 29 patients (85%). On ICU admission, grade 3–4 hepatic encephalopathy developed in 10 patients (29%); invasive mechanical ventilation, vasopressors, and renal replacement therapy were required for 8 (24%), 7 (21%), and 5 (15%) of the patients, respectively; the King’s College criteria (KCC) were fulfilled by 16 patients (47%). Of the 15 (44%) nontransplanted patients, 11 (73%) died during their hospital stay. Of the 19 (56%) transplanted patients, 4 (21%) died during their hospital stay. KCC were not associated with hospital mortality (p = 0.97), but they were significantly associated with LT (p = 0.008). Conclusions: In a Portuguese cohort of patients with ALF, non-paracetamol etiologies were predominant. Hospital mortality was much lower amongst transplanted patients.

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“…However, the dominant etiology of ALF is not similar even among Western countries due to its highly variable epidemiologic pattern. In a study conducted by Gulmez et al it was found that acute drug overdose, mainly from acetaminophen, was the etiology for ALF in 20% of the causes in 7 European countries overall, but with a very variable range of prevalence from 1% in Italy to 52% in Ireland (16). In another study by Escorsell et al the incidence of acetaminophen induced ALF was reported to be very low (2.2%) in Spain (17).…”

Section: Discussionmentioning

confidence: 96%

Acute Liver Failure, Etiology, and Outcome: An Experience in a Referral Liver Transplant Center

2017

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Background and Aims: Acute liver failure (ALF) caused by a sudden loss of liver function in patients without pre-existing liver disease is a rare condition and one of the emergencies in the field of hepatology. The common etiologies of ALF vary in different geographic areas and the course is highly variable among patients with different confounding factors. In this prospective study, ALF patients referred to our tertiary center were followed, and their data were analyzed for determinants of outcome. Methods: From March 2014 through February 2015, all adult and pediatric patients with a diagnosis of ALF, who were admitted to the gastroenterology and hepatology wards of our center with a large liver transplant program, were included in the study. Survivors were followed for at least 3 months after discharge from the hospital. Results: A total number of 45 (23 males) patients were included in the present study. The most common etiology was acute hepatitis A (15.6%), followed by drug induced liver injury (13.3%), and autoimmune hepatitis (11.1%), while most cases were classified as indeterminate ALF (35.6%). Overall survival rate was 71 %; 24.4% (11 patients) died, 46.7% (21 patients) survived without transplant, and 28.9% (13 patients) were transplanted, but 2 of them did not survive. Conclusions: Most cases of ALF in this study had unknown etiology. Acute hepatitis A was the most commonly identified cause. About half of the cases survived without transplantation with very good outcomes after 3 months, one-third received liver transplantation with excellent post-transplant survival.

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Liver transplant associated with paracetamol overdose: results from the seven‐country SALT study

Abstract: Paracetamol overdose was found to represent one-sixth of all-cause ALFT. There was a 50-fold difference in Europe in the rates of paracetamol overdose ALFT, and a 200-fold difference per million inhabitants.

Cited by 81 publications

References 27 publications

Liver Illness and Psychiatric Patients

Liver Illness and Psychiatric Patients

Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in Portugal

Acute Liver Failure, Etiology, and Outcome: An Experience in a Referral Liver Transplant Center

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