Published online Jul 27, 2019. doi: 10.4254/wjh.v11.i7.586
Peer-review started: April 23, 2019
First decision: June 5, 2019
Revised: June 19, 2019
Accepted: July 4, 2019
Article in press: July 5, 2019
Published online: July 27, 2019
Processing time: 95 Days and 5 Hours
Acute liver failure (ALF) is a life-threatening syndrome with varying aetiologies requiring complex care and multidisciplinary management. Its changing incidence, aetiology and outcomes over the last 16 years in the Australian context remain uncertain.
To describe the changing incidence, aetiology and outcomes of ALF in South Eastern Australia.
The database of the Victorian Liver Transplant Unit was interrogated to identify all cases of ALF in adults (> 16 years) in adults hospitalised between January 2002 and December 2017. Overall, 169 patients meeting criteria for ALF were identified. Demographics, aetiology of ALF, rates of transplantation and outcomes were collected for all patients. Transplant free survival and overall survival (OS) were assessed based on survival to discharge from hospital. Results were compared to data from a historical cohort from the same unit from 1988-2001.
Paracetamol was the most common aetiology of acute liver failure, accounting for 50% of cases, with an increased incidence compared with the historical cohort (P = 0.046). Viral hepatitis and non-paracetamol drug or toxin induced liver injury accounted for 15% and 10% of cases respectively. Transplant free survival (TFS) improved significantly compared to the historical cohort (52% vs 38%, P = 0.032). TFS was highest in paracetamol toxicity with spontaneous recovery in 72% of cases compared to 31% of non-paracetamol ALF (P < 0.001). Fifty-nine patients were waitlisted for emergency liver transplantation. Nine of these died while waiting for an organ to become available. Forty-two patients (25%) underwent emergency liver transplantation with a 1, 3 and 5 year survival of 81%, 78% and 72% respectively.
Paracetamol toxicity is the most common aetiology of ALF in South-Eastern Australia with a rising incidence over 30 years. TFS has improved, however it remains low in non-paracetamol ALF.
Core tip: Acute liver failure (ALF) is a life-threatening syndrome with varying aetiologies based on geographic location. Paracetamol is the most common cause of ALF in South Eastern Australia with a rising incidence over 30 years. Despite this, transplantation for paracetamol induced ALF is lower than other large centres at 4% with a comparable overall survival. Non-paracetamol ALF however portends a poor prognosis with less than one third surviving without emergency liver transplantation.