Institute of Liver Studies, King's College Hospital, London, UK.
Liver Int. 2010 Jul;30(6):826-33. doi: 10.1111/j.1478-3231.2010.02243.x. Epub 2010 Apr 8.
Acetaminophen-induced hepatotoxicity is the most common cause of acute liver failure (ALF) in the UK. Patients often consume the drug with suicidal intent or with a background of substance dependence.
We compared the severity of pretransplant illness, psychiatric co-morbidity, medical and psychosocial outcomes of all patients who had undergone liver transplantation (LT) emergently between 1999-2004 for acetaminophen-induced ALF (n=36) with age- and sex-matched patients undergoing emergent LT for non-acetaminophen-induced ALF (n=35) and elective LT for chronic liver disease (CLD, n=34).
Acetaminophen-induced ALF patients undergoing LT had a greater severity of pre-LT illness reflected by higher Acute Physiology and Chronic Health Evaluation II scores and requirement for organ support compared with the other two groups. Twenty (56%) acetaminophen-induced ALF patients had a formal psychiatric diagnosis before LT (non-acetaminophen-induced ALF=0/35, CLD=2/34; P<0.01 for all) and nine (25%) had a previous suicide attempt. During follow-up (median 5 years), there were no significant differences in rejection (acute and chronic), graft failure or survival between the groups (acetaminophen-induced ALF 1 year 87%, 5 years 75%; non-acetaminophen-induced ALF 88%, 78%; CLD 93%, 82%: P>0.6 log rank). Two acetaminophen-induced ALF patients reattempted suicide post-LT (one died 8 years post-LT).
Despite a high prevalence of psychiatric disturbance, outcomes for patients transplanted emergently for acetaminophen-induced ALF were comparable to those transplanted for non-acetaminophen-induced ALF and electively for CLD. Multidisciplinary approaches with long-term psychiatric follow-up may contribute to low post-transplant suicide rates seen and low rates of graft loss because of non-compliance.
对乙酰氨基酚引起的肝毒性是英国急性肝衰竭（ALF）最常见的原因。患者经常有意服用该药物，或有药物依赖背景。
我们比较了 1999 年至 2004 年间因对乙酰氨基酚引起的 ALF 而紧急接受肝移植（LT）的所有患者（n=36）与因非对乙酰氨基酚引起的 ALF 而紧急接受 LT（n=35）和因慢性肝病（CLD，n=34）而择期接受 LT 的年龄和性别匹配患者的移植前疾病严重程度、精神共病、医疗和社会心理结局。
与后两组相比，接受 LT 的对乙酰氨基酚引起的 ALF 患者的 LT 前疾病严重程度更高，表现在更高的急性生理学和慢性健康评估 II 评分和需要器官支持。20 名（56%）对乙酰氨基酚引起的 ALF 患者在 LT 前有正式的精神科诊断（非对乙酰氨基酚引起的 ALF=0/35，CLD=2/34；所有 P<0.01），9 名（25%）有过自杀企图。在随访期间（中位 5 年），各组之间在排斥（急性和慢性）、移植物失败或存活率方面没有显著差异（对乙酰氨基酚引起的 ALF 1 年 87%，5 年 75%；非对乙酰氨基酚引起的 ALF 88%，78%；CLD 93%，82%：P>0.6 对数秩）。2 名对乙酰氨基酚引起的 ALF 患者在 LT 后再次尝试自杀（1 名患者在 LT 后 8 年死亡）。
尽管存在较高的精神障碍患病率，但因对乙酰氨基酚引起的 ALF 而紧急接受移植的患者的结局与因非对乙酰氨基酚引起的 ALF 和因 CLD 而择期接受移植的患者相当。多学科方法和长期精神随访可能有助于降低移植后自杀率和因不遵医嘱导致的移植物丢失率。
