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. 2019 Jul 27;11(7):586-595.
doi: 10.4254/wjh.v11.i7.586.

Epidemiology and outcomes of acute liver failure in Australia

Penelope Hey  1 , Timothy P Hanrahan  1 , Marie Sinclair  1 , Adam G Testro  1 , Peter W Angus  1 , Adam Peterson  1 , Stephen Warrillow  2 , Rinaldo Bellomo  2 , Marcos V Perini  1 , Graham Starkey  1 , Robert M Jones  1 , Michael Fink  3 , Tess McClure  1 , Paul Gow  1
Affiliations

Epidemiology and outcomes of acute liver failure in Australia

Penelope Hey et al. World J Hepatol. .

Abstract

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.

Keywords: Acute; Australia; Liver failure; Liver transplant; Paracetamol; Victoria.

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Conflict of interest statement

Conflict-of-interest statement: All authors declare no conflict-of-interest related to this article.

Figures

Figure 1
Figure 1
Flowchart of outcomes of patients meeting criteria for acute liver failure.
Figure 2
Figure 2
Rate of paracetamol induced acute liver failure per capita.
See this image and copyright information in PMC

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