Long‐term outcome following liver transplantation for paracetamol overdose
Long‐term outcome following liver transplantation for paracetamol overdose
复制标题
扑热息痛过量肝移植后的长期结果
作者：
L. Khan;G. Oniscu;J. Powell
在英国，扑热息痛过量（POD）是需要肝移植的急性肝衰竭（ALF）的主要原因。描述14年期间（1992-2006年）在苏格兰肝移植中心进行POD原位肝移植（奥尔特）后的早期和晚期结局。数据来自前瞻性数据库结合病例记录审查。在127例因ALF而进行的肝移植中，44例为POD。中位年龄为30岁（范围18-51岁）。在18例患者（63.7%）中，POD与酒精/其他药物相关，9例（20.5%）发生交错用药过量，4例患者（9.1%）意外用药过量。19例患者（43.2%）有既往药物过量/精神疾病史。首次入院期间的移植后死亡率为30%（13例患者），而5例患者在随访期间死亡。5年患者生存率为54.5%，而移植物生存率为49.5%。大约23%的患者再次移植：原发性无功能（1），肝动脉血栓形成（3）和慢性排斥反应（2）。三名患者接受了后续移植;三名患者接受了两次进一步移植。9名患者（35%）继续存在社会/精神问题。奥尔特治疗POD与显著的早期和晚期发病率和死亡率相关。需要采取多学科方法来确定合适的候选人，并应立即进行移植。
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.