Treatment of Valproic Acid-Associated Hepatic Failure with Orthotopic Liver Transplantation

Bell, Edward; Shaefer, Mark S.; Markin, Rodney S.; Wood, Robert; Langnas, Alan Norman; Stratta, Robert J.; Shaw, Byers W.

doi:10.1177/106002809202600104

Cited by 14 publications

(11 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, prior studies have not been population‐based and did not capture a substantial number of patients undergoing liver transplantation. Studies that have included patients who underwent liver transplantation typically include few patients, such as case series 18, 19. In our analysis, post‐transplant survival was similar in the APAP and non‐APAP groups.…”

Section: Discussionmentioning

confidence: 78%

“…A novel finding in our study was that 42% of liver transplants for non‐APAP liver injury was attributed to just 4 drugs: isoniazid, propylthiouracil, phenytoin, and valproate. Severe liver injury due to these drugs has been well described 10–19. However, prior studies have not been population‐based and did not capture a substantial number of patients undergoing liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Liver transplantation for acute liver failure from drug induced liver injury in the United States

et al. 2004

View full text Add to dashboard Cite

Studies of acute liver failure from drugs have included cases mostly attributed to acetaminophen (APAP) but have reported limited data on other drugs. We used the United Network for Organ Sharing (UNOS) liver transplant database from 1990 to 2002 to identify recipients and estimate a U.S. population-based rate of liver transplantation due to acute liver failure from drugs. Patients were identified if their diagnosis was acute hepatic necrosis from an implicated drug at the time of transplant. Liver transplantation for drug hepatotoxicity accounted for 15% of liver transplants for acute liver failure over the study period. In our cohort (n ‫؍‬ 270), 206 (76%) recipients were female. APAP alone, or in combination with another drug, accounted for 133 (49%) cases. In the nonacetaminophen (non-APAP) group (n ‫؍‬ 137), the most frequently implicated drugs were: isoniazid, n ‫؍‬ 24 (17.5%); propylthiouracil, n ‫؍‬ 13 (9.5%); and phenytoin and valproate in 10 (7.3%) cases each. One-year patient and graft survival for the entire cohort was 77 and 71%, respectively. Among Caucasians (n ‫؍‬ 206) and AfricanAmericans (n ‫؍‬ 48), APAP only was implicated in 110 (53%) patients and 12 (25%) patients, respectively, and non-APAP drugs were implicated in 96 (47%) patients and 36 (75%) patients, respectively (P ‫؍‬ .0004). Among African-Americans in the non-APAP group, 28 (78%) were women. In conclusion four drugs were implicated in 42% of patients undergoing liver transplantation for acute liver failure due to drugs other than APAP. The increased frequency of African-American women undergoing liver transplantation for non-APAP drug induced liver injury warrants further study. (Liver

show abstract

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Liver transplantation for acute liver failure from drug induced liver injury in the United States

et al. 2004

View full text Add to dashboard Cite

show abstract

“…The cases reported here were 14, 20, and 21 years old when VPA was introduced. Three other cases of survival after LT for VPA‐ALF also have been reported; these patients were 19, 20, and 23 years old at the time of transplantation . In contrast, in Mindikoglu et al's series, 15 of 17 patients were less than 8 years old, with the oldest being 16 years old.…”

mentioning

confidence: 94%

Acute liver failure after valproate exposure: Liver transplantation may be indicated beyond childhood

McKiernan

2014

Liver Transpl

View full text Add to dashboard Cite

“…Serum amylase, lipase, liver function profile, electrolytes, glucose, and coagulation parameters should be quantified. Signs and symptoms associated with fulminant hepatic failure should be closely monitored because of numerous reports of fatalities from VPA-associated hepatic failure [43,80,85]. Bell et al reported a case of a 23-year-old woman who developed fulminant hepatic failure secondary to VPA toxicity that required orthotopic liver transplantation [85].…”

Section: How Do You Manage Patients With Valproic Acid Toxicity?mentioning

confidence: 99%

Case files of the Children’s Hospital of Michigan Regional Poison Control Center: The use of carnitine for the management of acute valproic acid toxicity

Katiyar

Aaron

2007

J. Med. Toxicol.

View full text Add to dashboard Cite

A 28-year-old African-American male was found unresponsive outside of his girlfriend's house around 7 o'clock in the morning. He spent the night at the girlfriend's house and was last witnessed to be awake about 12 hours earlier. The girlfriend and her family were unable to awaken the patient and called emergency medical services (EMS). There was no history of headache, dizziness, fever, chills, nausea, vomiting, seizures, trauma, depressive thoughts, or suicidal ideation. When EMS arrived, they administered 6 mg of naloxone intramuscularly without effect, and the patient was transported to the emergency department (ED).After arriving in the ED, the cardiac monitor displayed a narrow-complex rhythm with a rate of 85-90 per minute. His initial vital signs were: heart rate 91/min; blood pressure 148/80 mmHg; respiratory rate 24/min; temperature 35.1°C (95.1°F) rectally; and pulse oximetry 100% on non-rebreather face mask oxygen. A fingerstick glucose determination was 106 mg/dL.Physical examination revealed a well developed, well nourished individual who was obtunded and unresponsive. His pupils were 2 mm, unreactive to light, and without nystagmus. He had diffuse bilateral wheezing, regular heart rate without any murmurs, and decreased bowel sounds. The patient had warm skin with good distal pulses in all extremities and no cyanosis, erythema, or edema. There was no clonus or hyperreflexia, and the gag reflex was intact.His past medical history was only pertinent for an old gunshot wound to the head. He developed a seizure disorder and was taking divalproex, 500 mg BID. Reportedly, he was allergic to carbamazepine and phenytoin. The patient smoked cigarettes, but the family stated that he had no history of alcohol or illicit drug use.A 12-lead electrocardiogram showed a sinus rhythm with a rate of 92 bpm, a PR interval of 134 msec, a QRS duration of 90 msec, and a QTc of 601 msec. A head CT and chest radiograph were unremarkable. Laboratory tests were obtained.

show abstract

Treatment of Valproic Acid-Associated Hepatic Failure with Orthotopic Liver Transplantation

Abstract: Caution should be taken when initiating VPA therapy and clinicians should be familiar with the risk factors and clinical presentation of this reaction.

Cited by 14 publications

References 16 publications

Liver transplantation for acute liver failure from drug induced liver injury in the United States

Liver transplantation for acute liver failure from drug induced liver injury in the United States

Acute liver failure after valproate exposure: Liver transplantation may be indicated beyond childhood

Case files of the Children’s Hospital of Michigan Regional Poison Control Center: The use of carnitine for the management of acute valproic acid toxicity

Contact Info

Product

Resources

About