Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
Transpl Int. 2010 May 1;23(5):524-9. doi: 10.1111/j.1432-2277.2009.01007.x. Epub 2009 Nov 25.
Paracetamol overdose (POD) is a major cause of acute liver failure (ALF) requiring liver transplantation in the United Kingdom. To characterize the early and late outcome after orthotopic liver transplantation (OLT) for POD in the Scottish Liver Transplant Unit over a 14-year period (1992-2006). Data were obtained from a prospective database combined with case-note review. Of 127 liver transplants performed for ALF, 44 were for POD. The median age was 30 (range 18-51). In 18 patients (63.7%), POD was associated with alcohol/other drugs, nine (20.5%) had a staggered overdose and four patients (9.1%) accidentally overdosed. Nineteen patients (43.2%) had a history of previous overdose/psychiatric illness. Post-transplant mortality during the index admission was 30% (13 patients), whilst five patients died during follow-up. The actuarial 5-year patient survival was 54.5%, whilst graft survival was 49.5%. Some 23% of the patients were re-transplanted: primary nonfunction (1), hepatic artery thrombosis (3) and chronic rejection (2). Three patients had a subsequent transplant; three patients had two further transplants. Nine patients (35%) continue to have social/psychiatric issues. OLT for POD is associated with significant early and late morbidity and mortality. A multidisciplinary approach is required to identify the suitable candidates, in whom transplantation should be pursued promptly.
扑热息痛过量（POD）是导致英国需要进行肝移植的急性肝衰竭（ALF）的主要原因。本研究旨在描述苏格兰肝移植中心在过去 14 年（1992-2006 年）接受 POD 患者进行原位肝移植（OLT）后的早期和晚期结果。数据来自前瞻性数据库和病例记录回顾。在因 ALF 进行的 127 例肝移植中，44 例是因 POD。中位年龄为 30 岁（范围 18-51 岁）。在 18 例（63.7%）患者中，POD 与酒精/其他药物有关，9 例（20.5%）为交错过量用药，4 例患者（9.1%）意外过量用药。19 例患者（43.2%）有既往过量用药/精神病史。指数入院期间的移植后死亡率为 30%（13 例），而 5 例患者在随访期间死亡。5 年患者生存率为 54.5%，而移植物存活率为 49.5%。约 23%的患者需要再次移植：原发性无功能（1 例）、肝动脉血栓形成（3 例）和慢性排斥反应（2 例）。有 3 例患者进行了后续移植，3 例患者进行了两次以上的移植。9 例患者（35%）仍存在社会/精神问题。OLT 治疗 POD 与显著的早期和晚期发病率和死亡率相关。需要多学科方法来确定合适的候选者，尽快进行移植。
