Spontaneous survivors of acetaminophen overdose have significantly
lower overall health compared to survivors or transplant recipients
following acute liver failure caused by non-drug induced liver injury
according to a new study published online in Liver Transplantation,
a journal of the American Association for the Study of Liver Diseases
and the International Liver Transplantation Society. Findings show that
acetaminophen overdose survivors report more days of impaired mental
and physical health, and activity limitations due to poor health, pain,
anxiety and depression.
Patients are diagnosed with acute liver failure (ALF)
when severe liver dysfunction occurs, along with blood clotting or
bleeding disorders (coagulopathy) and compromised brain function
(encephalopathy). Studies report that up to 3,000 patients develop ALF
in the U.S. each year and 67% of these patients will survive, but nearly
30% of these patients require emergency liver transplantation.
However, long-term consequences of ALF and health-related quality of
life (HRQOL) of survivors, remains unclear.
To expand understanding of the quality of life and
function of adult ALF survivors, a team led by Dr. Robert Fontana from
the University of Michigan Medical Center in Ann Arbor conducted a
prospective observational study. Patients diagnosed with ALF between
January 1998 and July 2010 were included in the study. Participants
agreed to follow-up at one and two years following ALF.
Results show that of the 282 ALF patients—125 liver
transplantation recipients (10.7% due to acetaminophen overdose) and
157 spontaneous survivors of which 95 were acetaminophen overdose
patients and 62 were survivors of non-drug induced liver failure.
Patients that survived acetaminophen overdose reported significantly
lower general health scores. Acetaminophen overdose survivors had
higher rates of substance abuse and psychiatric disease compared to
non-acetaminophen overdose survivors and transplant recipients.
Participants who were survivors of non-intentional acetaminophen
overdose were less likely to have psychiatric comorbidity compared to
patients who intentionally overdosed at 48% and 82%, respectively.
The combined group of spontaneous survivors of ALF
reported “fair/poor” health and more than 14 days of physical or mental
health impairment compared to the general population in the U.S. This
group also had more limitation in functional activity due to poor
health. “Our findings indicate that adult survivors of ALF have reduced
quality of life compared to those of similar age and gender in the
general population,” concludes Dr. Fontana. “Additional investigations
of brain function by our team are underway to further understanding of
the type and severity of cognitive impairment reported by ALF
This current study was funded in part by a grant from
the National Institute of Diabetes, Digestive and Kidney Diseases (DK
U-01-58369) to the United States Acute Liver Failure Study Group
(ALFSG), which is led by Dr. William Lee, Professor of Internal Medicine
at UT Southwestern Medical Center in Dallas. ALFSG is a National
Institutes of Health-funded consortium of investigators in the United
States focused on studying acute liver failure.
Full citation: “Quality of Life is
Significantly Impaired in Long-Term Survivors of Acute Liver Failure and
Particularly In Acetaminophen Overdose Patients.” Amol S. Rangnekar,
Caitlyn Ellerbe, Valerie Durkalski, Brendan McGuire, William M. Lee and
Robert J. Fontana. Liver Transplantation; (DOI: 10.1002/lt.23688) Published Online: June 18, 2013.
Author Contact: Media wishing to speak with
Dr. Fontana may contact Mary Masson at 734-764-2220. For those
interested in speaknig with Dr Lee of UTSW may contact Debbie Bolles at
About the Journal
Liver Transplantation is published by Wiley on behalf of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.
Since the first application of liver transplantation in a clinical
situation was reported more than twenty years ago, there has been a
great deal of growth in this field and more is anticipated. As an
official publication of the AASLD and the ILTS,
Liver Transplantation delivers current, peer-reviewed articles on
surgical techniques, clinical investigations and drug research — the
information necessary to keep abreast of this evolving specialty. For
more information, please visit http://wileyonlinelibrary.com/journal/lt.
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Labels: acetaminophen overdose, liver failure