Etiology and outcome for 295 patients with acute liver failure in the United States

Little information is available on acute liver failure (ALF) in the United States. We gathered demographic data retrospectively for a 2-year period fr om July 1994 to June 1996 on all cases of ALF from 13 hospitals (12 liver t ransplant centers). Data on the patients included age, hepatic coma grade o n admission, presumed cause, transplantation, and outcome, Among 295 patien ts, 74 (25%) survived spontaneously, 121 (41%) underwent transplantation, a nd 99 (34%) died without undergoing transplantation. Ninety-two of 121 pati ents (76%) survived 1 year after transplantation, Acetaminophen overdose wa s the most frequent cause (60 patients; 20%), followed by cryptogenic/non A non B non C (NANBNC; 15%), idiosyncratic drug reactions (12%), hepatitis B (10%), and hepatitis A (7%), Spontaneous survival rates were highest for p atients with acetaminophen overdose (57%) and hepatitis A (40%) and lowest for those with Wilson's disease (no survivors of 18 patients), The transpla ntation rate was highest for Wilson's disease (17 of 18 patients; 94%) and lowest for autoimmune hepatitis (29%) and acetaminophen overdose (12%), Age did not differ between survivors and nonsurvivors, perhaps reflecting a se lection bias for patients transferred to liver transplant centers, Coma gra de on admission was not a significant determinant of outcome, but showed a trend toward affecting both survival and transplantation rate, These findin gs on retrospectively studied patients from the United States differ from t hose previously gathered in the United Kingdom and France, highlighting the need for further study of trends in each country. Copyright (C) 1999 by th e American Association for the Study of Liver Diseases.