The Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
HPB (Oxford). 2009 Aug;11(5):429-34. doi: 10.1111/j.1477-2574.2009.00086.x.
Acute liver failure (ALF) is a clinical syndrome characterized by the sudden onset of coagulopathy and encephalopathy. The outcome is unpredictable and is associated with high morbidity and mortality. We reviewed our experience to identify the aetiology and study the outcome of acute liver failure.
A total of 1237 patients who presented with acute liver failure between January 1992 and May 2008 were included in this retrospective study. Liver transplantation was undertaken based on the King's College Hospital criteria. Data were obtained from the units prospectively collected database. The following parameters were analysed: patient demographics, aetiology, operative intervention, overall outcome, 30-day mortality and regrafts.
There were 558 men and 679 women with a mean age of 37 years (range: 8-78 years). The most common aetiology was drug-induced liver failure (68.1%), of which 90% was as a result of a paracetamol overdose. Other causes include seronegative hepatitis (15%), hepatitis B (2.6%), hepatitis A (1.1%), acute Budd-Chiari syndrome (1.5%), acute Wilson's disease (0.6%), subacute necrosis(3.2%) and miscellaneous (7.8%). Three hundred and twenty-seven patients (26.4%) were listed for liver transplantation, of which 263 patients successfully had the procedure (80.4%). The current overall survival after transplantation was 70% with a median follow-up of 57 months. After transplantation for ALF, the 1-year, 5-year and 10-year survival were 76.7%, 66% and 47.6%, respectively. The 30-day mortality was 13.7%. Out of the 974 patients who were not transplanted, 693 patients are currently alive. Among the 281 patients who died without transplantation, 260 died within 30 days of admission (26.7%). Regrafting was performed in 31 patients (11.8%), the most common indication being hepatic artery thrombosis (11 patients).
Paracetamol overdose was the most common cause of acute liver failure. Liver transplantation, when performed for acute liver failure, has good long-term survival.
急性肝衰竭（ALF）是一种以凝血功能障碍和肝性脑病突然发作为特征的临床综合征。其预后难以预测，且与高发病率和高死亡率相关。我们回顾了自己的经验，以确定急性肝衰竭的病因，并研究其结局。
本回顾性研究纳入了 1992 年 1 月至 2008 年 5 月期间因急性肝衰竭而就诊的 1237 例患者。肝移植根据国王学院医院的标准进行。数据来自单位前瞻性收集的数据库。分析了以下参数：患者人口统计学、病因、手术干预、总体结局、30 天死亡率和再次移植。
患者中有 558 名男性和 679 名女性，平均年龄为 37 岁（范围：8-78 岁）。最常见的病因是药物性肝衰竭（68.1%），其中 90%是由于对乙酰氨基酚过量。其他病因包括血清阴性肝炎（15%）、乙型肝炎（2.6%）、甲型肝炎（1.1%）、急性 Budd-Chiari 综合征（1.5%）、急性威尔逊病（0.6%）、亚急性坏死（3.2%）和其他（7.8%）。327 例（26.4%）患者被列入肝移植名单，其中 263 例患者成功接受了该手术（80.4%）。移植后的总体存活率为 70%，中位随访时间为 57 个月。急性肝衰竭移植后 1 年、5 年和 10 年的存活率分别为 76.7%、66%和 47.6%。30 天死亡率为 13.7%。未接受移植的 974 例患者中，目前有 693 例存活。281 例未经移植而死亡的患者中，260 例在入院后 30 天内死亡（26.7%）。31 例（11.8%）患者进行了再次移植，最常见的指征是肝动脉血栓形成（11 例）。
对乙酰氨基酚过量是急性肝衰竭最常见的病因。对于急性肝衰竭，肝移植具有良好的长期生存率。
