Cooper Sheldon C, Aldridge Roland C, Shah Tahir, Webb Kerry, Nightingale Peter, Paris Sue, Gunson Bridget K, Mutimer David J, Neuberger James M
Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham National Health Service Foundation Trust, Edgbaston, Birmingham, United Kingdom.
Liver Transpl. 2009 Oct;15(10):1351-7. doi: 10.1002/lt.21799.
Paracetamol (acetaminophen) hepatotoxicity, whether due to intentional overdose or therapeutic misadventure, is an indication for liver transplantation in selected cases. However, there is a concern that long-term outcomes may be compromised by associated psychopathology that may predispose patients to further episodes of self-harm or poor treatment adherence. We therefore undertook a retrospective analysis of patients transplanted for paracetamol-induced fulminant hepatic failure (FHF) to determine their long-term outcomes, psychiatric problems, and compliance and whether these issues could be predicted from pretransplant information. Records from patients undergoing liver transplantation for paracetamol-associated liver failure in this unit and 2 comparison groups (patients undergoing liver replacement for FHF from other causes and for chronic liver diseases) were examined. Of 60 patients transplanted for paracetamol-induced FHF between 1989 and 2007, 44 (73%) survived to discharge. Currently, 35 patients (58%) are surviving at an average of 9 years post-transplantation. The incidence of psychiatric disease (principally depression) and 30-day mortality were greatest in the paracetamol group, but for those who survived 30 days, there was no difference in long-term survival rates between the groups. Adherence to follow-up appointments and compliance with immunosuppression were lowest in the paracetamol overdose group. Poor adherence was not predicted by any identifiable premorbid psychiatric conditions. Two patients grafted for paracetamol FHF died from self-harm (1 from suicide and 1 from alcoholic liver disease after 5 years). This study suggests that, notwithstanding the shortage of donor liver grafts, transplantation is an appropriate therapy in selected patients, although close follow-up is indicated.
对乙酰氨基酚（扑热息痛）所致肝毒性，无论是因故意过量服用还是治疗失误，在某些特定病例中都是肝移植的指征。然而，人们担心相关的精神病理学问题可能会影响长期预后，使患者更容易出现进一步的自我伤害行为或治疗依从性差的情况。因此，我们对因对乙酰氨基酚所致暴发性肝衰竭（FHF）而接受肝移植的患者进行了一项回顾性分析，以确定他们的长期预后、精神问题、依从性，以及这些问题是否可以根据移植前的信息进行预测。我们检查了本单位因对乙酰氨基酚相关性肝衰竭接受肝移植患者以及2个对照组（因其他原因的FHF和慢性肝病接受肝移植的患者）的记录。在1989年至2007年间因对乙酰氨基酚所致FHF接受肝移植的60例患者中，44例（73%）存活至出院。目前，35例患者（58%）存活，平均移植后9年。对乙酰氨基酚组精神疾病（主要是抑郁症）的发病率和30天死亡率最高，但对于存活30天的患者，各组之间的长期生存率没有差异。对乙酰氨基酚过量组的随访预约依从性和免疫抑制治疗依从性最低。任何可识别的病前精神状况均无法预测依从性差的情况。2例因对乙酰氨基酚FHF接受肝移植的患者死于自我伤害（1例自杀，1例5年后死于酒精性肝病）。这项研究表明，尽管供肝短缺，但对于某些特定患者，肝移植仍是一种合适的治疗方法，不过仍需密切随访。
