Epidemiology and outcomes of acute liver failure in Australia

Table 1 Drugs and toxins implicated in cases of acute liver failure managed at the Victorian Liver Transplant Unit from 2002-2017

Drug/Toxins	Cases of ALF	Waitlisted for ELT	ELT
	(n = 101)	(n = 21)	(n = 13)
Paracetamol	84	11	3
Antibiotics	4	2	2
Amoxicillin/clavulanate (2), clarithromycin, isoniazid
Infliximab	2	2	2
Illicit drugs	4	1	1
LSD, injected buprenorphine, amphetamines, MDMA
NSAIDs	1	1	1
Amanita phalloides	1	1	1
Herbal medicines
Black cohosh herb, kava kava	2	2	2
Other
Moxonidine, fenofibrate, chlorambucil	3	1	1

ALF: Acute liver failure; ELT: Emergency liver transplantation; NSAIDs: Non-steroid anti-inflammatory drugs; LSD: Lysergic acid diethylamide; MDMA: Methylenedioxymethamphetamine; NSAIDs: Non-steroidal anti-inflammatory drugs

Table 2 Demographics and aetiology of acute liver failure managed at the Victorian Liver Transplant Unit in a historical cohort^† compared to current series

	1988-20011 (n = 80)		2002-2017 (n = 169)		P value
	n	%	n	%
Referral rate2, median [IQR]	1.2 [0.6;1.6]		1.6 [1.3;1.7]		0.020
Age, yr, median [IQR]	36 [27.0;48.0]		40 [30.0;52.0]		0.168
Gender
Male	16	20.0	37	21.9
Female	64	80.0	132	78.1	0.733
Aetiology
Paracetamol	29	36.3	84	49.7	0.046
Viral hepatitis	11	13.8	26	15.3	0.734
Hepatitis B	8	10.0	20	11.8	0.669
Hepatitis A	3	3.8	4	2.4	0.538
Varicella zoster	0	0.0	1	0.1	0.491
Herpes simplex	0	0.0	1	0.1	0.491
Non-paracetamol drug/toxin	5	6.3	17	10.1	0.323
Indeterminate	27	33.8	21	12.4	<0.001
Autoimmune hepatitis	0	0.0	9	5.3	0.036
Other	8	10.0	12	7.1	0.432
Waitlisted for transplantation	35	43.8	59	33.5	0.179
Waitlist mortality	9	25.7	8	13.6	0.139
Liver transplantation	26	32.5	42	24.9	0.206
Transplant-free survival	30	37.5	88	52.1	0.032
Overall hospital survival	50	62.5	122	72.2	0.122

¹Gow et al[12], 2001;

²Referral rate per million population per year. IQR: Interquartile range.

Table 3 Outcomes of acute liver failure managed at the Victorian Liver Transplant Unit in a historical cohort^† compared to the current series

Aetiology	TFS (%)					OS (%)
	1988-20011		2002-2017		P value	1988-20011		2002-2017		P value
	n	%	n	%		n	%	n	%
Paracetamol	20	69.0	62	73.8	0.614	21	72.4	65	77.4	0.589
Non-paracetamol	10	19.6	26	30.6	0.160	29	56.9	57	67.1	0.230
Viral hepatitis	2	18.2	10	38.4	0.228	5	45.5	18	69.2	0.173
HBV	2	25.0	7	35.0	0.609	4	50.0	14	70.0	0.318
HAV	0	0.0	3	75.0	0.047	1	0.33	3	75.0	0.270
Drug/toxin induced	3	60.0	5	29.4	0.211	4	80.0	12	70.6	0.678
Autoimmune hepatitis	0	0.0	3	33.3	-	0	0.0	6	66.7	-
Indeterminate hepatitis	5	18.5	2	9.5	0.381	15	55.5	14	66.7	0.435
Other	0	0.0	6	50.0	0.017	5	62.5	7	58.3	0.852

¹Gow et al[12], 2001. TFS: Transplant-free survival; OS: Overall hospital survival; HBV: Hepatitis B virus; HAV: Hepatitis A virus.