Abstract

Liver Transplantation and SurgeryVolume 5, Issue 1 p. 29-34 Original ArticleFree Access Etiology and outcome for 295 patients with acute liver failure in the united states Frank V. Schiødt, Frank V. Schiødt University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorEvren Atillasoy, Evren Atillasoy University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorA. Obaid Shakil, A. Obaid Shakil University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorEugene R. Schiff, Eugene R. Schiff University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorCary Caldwell, Cary Caldwell University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorKris V. Kowdley, Kris V. Kowdley University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorRisë Stribling, Risë Stribling University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorJeffrey S. Crippin, Jeffrey S. Crippin University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorSteven Flamm, Steven Flamm University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorKenneth A. Somberg, Kenneth A. Somberg University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorHugo Rosen, Hugo Rosen University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorTim M. McCashland, Tim M. McCashland University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorJ. Eileen Hay, J. Eileen Hay University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorWilliam M. Lee, Corresponding Author William M. Lee University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersAddress reprint requests to William M. Lee, MD, Liver Unit, UT Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75235-9151Search for more papers by this authorthe Acute Liver Failure Study Group, the Acute Liver Failure Study GroupSearch for more papers by this author Frank V. Schiødt, Frank V. Schiødt University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorEvren Atillasoy, Evren Atillasoy University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorA. Obaid Shakil, A. Obaid Shakil University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorEugene R. Schiff, Eugene R. Schiff University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorCary Caldwell, Cary Caldwell University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorKris V. Kowdley, Kris V. Kowdley University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorRisë Stribling, Risë Stribling University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorJeffrey S. Crippin, Jeffrey S. Crippin University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorSteven Flamm, Steven Flamm University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorKenneth A. Somberg, Kenneth A. Somberg University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorHugo Rosen, Hugo Rosen University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorTim M. McCashland, Tim M. McCashland University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorJ. Eileen Hay, J. Eileen Hay University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersSearch for more papers by this authorWilliam M. Lee, Corresponding Author William M. Lee University of Texas Southwestern Medical Center, Dallas, TX, and 12 US Liver CentersAddress reprint requests to William M. Lee, MD, Liver Unit, UT Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75235-9151Search for more papers by this authorthe Acute Liver Failure Study Group, the Acute Liver Failure Study GroupSearch for more papers by this author First published: 30 December 2003 https://doi.org/10.1002/lt.500050102Citations: 291AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Little information is available on acute liver failure (ALF) in the United States. We gathered demographic data retrospectively for a 2-year period from July 1994 to June 1996 on all cases of ALF from 13 hospitals (12 liver transplant centers). Data on the patients included age, hepatic coma grade on admission, presumed cause, transplantation, and outcome. Among 295 patients, 74 (25%) survived spontaneously, 121 (41%) underwent transplantation, and 99 (34%) died without undergoing transplantation. Ninety-two of 121 patients (76%) survived 1 year after transplantation. Acetaminophen overdose was the most frequent cause (60 patients; 20%), followed by cryptogenic/non A non B non C (NANBNC; 15%), idiosyncratic drug reactions (12%), hepatitis B (10%), and hepatitis A (7%). Spontaneous survival rates were highest for patients with acetaminophen overdose (57%) and hepatitis A (40%) and lowest for those with Wilson's disease (no survivors of 18 patients). The transplantation rate was highest for Wilson's disease (17 of 18 patients; 94%) and lowest for autoimmune hepatitis (29%) and acetaminophen overdose (12%). Age did not differ between survivors and nonsurvivors, perhaps reflecting a selection bias for patients transferred to liver transplant centers. Coma grade on admission was not a significant determinant of outcome, but showed a trend toward affecting both survival and transplantation rate. These findings on retrospectively studied patients from the United States differ from those previously gathered in the United Kingdom and France, highlighting the need for further study of trends in each country. References 1 Lee WM. Medical progress: Acute liver failure. N Engl J Med 1993; 329: 1862– 1872. MEDLINE 2 Ritt DJ, Whelan G, Werner DJ, Eigenbrodt EH, Schenker S, Combes B. Acute hepatic necrosis with stupor or coma. An analysis of thirty-one patients. Medicine 1969; 48: 151– 172. MEDLINE 3 Rakela J, Lange SM, Ludwig J, Baldus WP. 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