Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Epidemiology and outcomes of acute liver failure in Australia
Penelope Hey, Timothy P Hanrahan, Marie Sinclair, Adam G Testro, Peter W Angus, Adam Peterson, Stephen Warrillow, Rinaldo Bellomo, Marcos V Perini, Graham Starkey, Robert M Jones, Michael Fink, Tess McClure, Paul Gow
Penelope Hey, Timothy P Hanrahan, Marie Sinclair, Adam G Testro, Peter W Angus, Adam Peterson, Marcos V Perini, Graham Starkey, Robert M Jones, Tess McClure, Paul Gow, Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
Penelope Hey, Marie Sinclair, Adam G Testro, Peter W Angus, Stephen Warrillow, Rinaldo Bellomo, Marcos V Perini, Graham Starkey, Robert M Jones, Tess McClure, Paul Gow, The University of Melbourne, Melbourne 3052, Australia
Stephen Warrillow, Rinaldo Bellomo, Department of Intensive Care, Austin Heath, Melbourne 3084, Australia
Michael Fink, Department of Surgery, Austin Health, Melbourne 3084, Australia
Author contributions: All authors have contributed to this manuscript and have agreed on the content; Hey P, Hanrahan T and Gow P were involved in the study design; Hey P, Hanrahan T and Peterson A were involved with data collection and analysis; Hanrahan H provided statistical support; Hey P, Gow P, Hanrahan T, Sinclair M, Testro A, Warrillow S, Bellomo R, Perini M, Starkey G, Jones R, Fink M and McClure T were involved with data interpretation, drafting and revising the work; All authors provided approval for the final version to be published.
Institutional review board statement: This study was approved through the Austin Health Human Research Ethics Committee.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data collected as a clinical Audit.
Conflict-of-interest statement: All authors declare no conflict-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Penelope Hey, MBBS, BMedSci, Liver Transplant Unit, Austin Health, 145 Studley Road, Heidelberg 3084, Australia.
penelope.hey@austin.org.au
Telephone: +61-3-94965353 Fax: +61-3-94963487
Received: April 23, 2019
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
BACKGROUND
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.
AIM
To describe the changing incidence, aetiology and outcomes of ALF in South Eastern Australia.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
