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
ARTICLE HIGHLIGHTS
Research background
Acute liver failure (ALF) is a rare clinical syndrome with varying aetiologies based on geographic location. This condition is associated with high morbidity and mortality, and emergency liver transplantation is often life-saving.
Research motivation
In Australia, published data from 1988-2001 demonstrated that paracetamol toxicity was the major cause of ALF, followed by non-A non-B hepatitis. An updated analysis of aetiologies and outcomes in an Australian context is therefore required.
Research objections
This study aimed to provide a description of the aetiologies and outcomes of acute liver failure presenting to a large Australian liver transplant centre. We also aimed to describe changes over the past thirty years since the availability of liver transplantation for this condition.
Research methods
This is a retrospective cohort study of all patients admitted to the Victorian Liver Transplant Unit from 2001-2017. Data were compared to previous published series from the unit from 1988-2001, and as continuous data, to assess changes in aetiologies and outcomes over the past 30 years.
Research results
Paracetamol toxicity accounted for half of all cases of ALF, with a rise in the incidence of this condition over the past 30 years. Despite this observation, rates of liver transplantation for this condition are low at 4%, with an excellent overall survival. Rates of emergency liver transplantation were highest in indeterminate hepatitis and non-paracetamol drug induced liver injury. Transplant-free survival improved in this cohort compared to the historical cohort, however there was no significant change in overall survival.
Research conclusions
Paracetamol represents the major cause of ALF in South-Eastern Australia with a concerning rise in its incidence over the past 30 years. Transplant-free survival has improved but remains low for ALF due to non-paracetamol causes.
Research perspectives
This study shows a concerning rise in the incidence of paracetamol induced ALF in Australia, raising important questions regarding awareness and public health strategies to curb this rise. Larger multi-centre studies are required to confirm this observation. Transplant-free survival improved in this population similar to reports from other large international series, highlighting advances in supportive care.
