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Liver transplantation after paracetamol overdose
J G O'Grady1, J Wendon, K C Tan
1Institute of Liver Studies, King's College School of Medicine and Dentistry, London.
BMJ (Clinical Research Ed.)
|July 27, 1991
Summary
Liver transplantation plays a limited role in managing acetaminophen (paracetamol) overdose-induced liver failure. While some patients with poor prognoses benefit, intensive medical care offers better survival for many.
Area of Science:
- Hepatology
- Transplantation Surgery
- Toxicology
Background:
- Acetaminophen (paracetamol) overdose is a common cause of acute liver failure.
- Liver transplantation is a life-saving option for patients with irreversible liver damage.
- The precise role of liver transplantation in acetaminophen-induced liver failure requires evaluation.
Purpose of the Study:
- To assess the effectiveness and role of liver transplantation in patients with acetaminophen overdose.
- To determine patient selection criteria and outcomes for liver transplantation in this context.
Main Methods:
- Prospective study conducted over 18 months at a London Liver Unit.
- Inclusion of consecutive patients evaluated for liver transplantation following acetaminophen overdose.
- Monitoring of prognostic indicators, transplant selection, procedure performance, and patient survival.
Main Results:
- 30 of 37 patients with a good prognosis survived with intensive medical care.
- Of 14 patients with very poor prognoses listed for urgent transplant, 6 received transplants, with 4 survivors.
- Three of 15 patients with poor prognoses not selected for transplantation also survived.
Conclusions:
- Liver transplantation has a defined, yet restricted, role in managing acetaminophen-induced fulminant hepatic failure.
- Intensive medical management offers a better survival rate for many patients with acetaminophen overdose.