Liver transplantation for acute liver failure from drug induced liver injury in the United States
Liver transplantation for acute liver failure from drug induced liver injury in the United States
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DOI：
10.1002/lt.20204
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发表时间：
2004-08-01
影响因子：
4.6
通讯作者：
Watkins, P
中科院分区：
文献类型：
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作者：
Russo, MW;Galanko, JA;Watkins, P
药物引起急性肝衰竭的研究包括大多数归因于对乙酰氨基酚（APAP）的病例，但报告的其他药物数据有限。我们使用1990年至2002年的联合器官共享网络（UNOS）肝移植数据库来识别受体，并估计美国人口因药物引起的急性肝功能衰竭而进行肝移植的比率。如果患者在移植时被诊断为由相关药物引起的急性肝坏死，则对其进行识别。在研究期间，药物肝毒性肝移植占急性肝功能衰竭肝移植的15%。在队列（n = 270）中，206例（76%）接受者为女性。APAP单独使用或与另一种药物联合使用占133例（49%）。在非对乙酰氨基酚（非APAP）组（n = 137）中，最常涉及的药物为：异烟肼，n = 24（17.5%）;丙基硫氧嘧啶，n = 13（9.5%）;苯妥英和丙戊酸盐各10例（7.3%）。整个队列的一年患者和移植物存活率分别为77%和71%。在白人（n = 206）和非洲裔美国人（n = 48）中，仅APAP分别涉及10（53%）例患者和12（25%）例患者，非APAP药物分别涉及96（47%）例患者和36（75%）例患者（P = 0.0004）。在非APAP组的非洲裔美国人中，28人（78%）是女性。总之，四种药物与42%因APAP以外的药物导致急性肝功能衰竭而接受肝移植的患者有关。非裔美国妇女因非APAP药物引起的肝损伤而接受肝移植的频率增加值得进一步研究。
Studies of acute liver failure from drugs have included cases mostly attributed to acetaminophen (APAP) but have reported limited data on other drugs. We used the United Network for Organ Sharing (UNOS) liver transplant database from 1990 to 2002 to identify recipients and estimate a U.S. population-based rate of liver transplantation due to acute liver failure from drugs. Patients were identified if their diagnosis was acute hepatic necrosis from an implicated drug at the time of transplant. Liver transplantation for drug hepatotoxicity accounted for 15% of liver transplants for acute liver failure over the study period. In out cohort (n = 270), 206 (76%) recipients were female. APAP alone, or in combination with another drug, accounted for 133 (49%) cases. In the non-acetaminophen (non-APAP) group (n = 137), the most frequently implicated drugs were: isoniazid, n = 24 (17.5%), propylthiouracil, n = 13 (9.5%); and phenytoin and valproate in 10 (7.3%) cases each. One-year patient and graft survival for the entire cohort was 77 and 71%, respectively. Among Caucasians (n = 206) and African-Americans (n = 48), APAP only was implicated in I 10 (53%) patients and 12 (25%) patients, respectively, and non-APAP drugs were implicated in 96 (47%) patients and 36 (75%) patients, respectively (P = .0004). Among African-Americans in the non-APAP group, 28 (78%) were women. In conclusion four drugs were implicated in 42% of patients undergoing liver transplantation for acute liver failure due to drugs other than APAP. The increased frequency of African-American women undergoing liver transplantation for non-APAP drug induced liver injury warrants further study.