Liver transplantation for acute liver failure from drug induced liver injury in the United States

BACKGROUND: Acute liver failure is a rare condition in which massive liver injury is associated with the rapid development of hepatic encephalopathy. Although viral hepatitis and drug-induced liver injury are the most common causes, no specific etiology is found in a substantial proportion of cases reported from Europe and the United States.AIM: To determine the etiology and outcome of patients with acute liver failure in the authors’ institution.PATIENTS AND METHODS: The charts of 81 consecutive patients admitted to Saint-Luc between 1991 and 1999 were reviewed.RESULTS: The etiology was viral in 27 cases (33.2%), toxic or drug-induced in 22 (27.2%), of unknown origin in 22 (27.2%) and due to various causes in 10 (12.3%) (autoimmune, vascular, cancer). Of the 81 patients, 16% survived without liver transplantation, and 84% died or underwent liver transplantation. Survival without liver transplantation differed according to the mode of presentation: the survival rate was 27% in patients with hyperacute liver failure, 7% in those with acute liver failure and 0% in those with subacute liver failure. Among the 38 patients who underwent liver transplantation, survival one year after transplantation was 71%. In the 30 patients who died without liver transplantation, the main causes of death were cerebral edema and sepsis.CONCLUSIONS: Acute liver failure is associated with a high mortality, and liver transplantation is the treatment of choice. In a significant proportion of cases, the etiology remains undetermined and is probably related to yet unidentified hepatotropic viruses.

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Outcome of liver transplantation for drug-induced acute liver failure in the United States: Analysis of the united network for organ sharing database

Liver Transplantation ◽

10.1002/lt.21692 ◽

2009 ◽

Vol 15 (7) ◽

pp. 719-729 ◽

Cited By ~ 77

Author(s):

Ayse L. Mindikoglu ◽

Laurence S. Magder ◽

Arie Regev

Keyword(s):

United States ◽

Liver Transplantation ◽

Liver Failure ◽

Acute Liver Failure ◽

The United States ◽

Drug Induced ◽

United Network

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Acute Liver Failure

Journal of Intensive Care Medicine ◽

10.1177/0885066615609271 ◽

2016 ◽

Vol 31 (10) ◽

pp. 642-653 ◽

Cited By ~ 12

Author(s):

Carmi S. Punzalan ◽

Curtis T. Barry

Keyword(s):

Liver Transplantation ◽

Hepatic Encephalopathy ◽

Liver Injury ◽

Liver Failure ◽

Acute Liver Failure ◽

Specific Treatment ◽

The United States ◽

Drug Induced ◽

Life Threatening ◽

Transplantation Center

Acute liver failure is life threatening liver injury with coagulopathy and hepatic encephalopathy within 26 weeks and generally, in the absence of preexisting liver disease. Fulminant liver failure occurs when hepatic encephalopathy occurs within 8 weeks of jaundice. The majority of patients with ALF are women with the median age of 38 years. In the United States, drug induced liver injury including acetaminophen causes the majority of ALF cases. The etiology of ALF should be determined, if possible, because many causes have a specific treatment. The mainstay for ALF is supportive care and liver transplantation, if necessary. There are multiple prognostic criteria available. Prognosis can be poor and patients should be referred to a liver transplantation center as soon as possible.

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Causes, Clinical Features, and Outcomes From a Prospective Study of Drug-Induced Liver Injury in the United States

Yearbook of Medicine ◽

10.1016/s0084-3873(09)79531-8 ◽

2009 ◽

Vol 2009 ◽

pp. 458-459

Author(s):

D.M. Harnois

Keyword(s):

United States ◽

Liver Injury ◽

Prospective Study ◽

Clinical Features ◽

The United States ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

A Prospective Study

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A Patient with Nafcillin-Associated Drug-Induced Liver Failure

Case Reports in Gastroenterology ◽

10.1159/000480071 ◽

2017 ◽

Vol 11 (3) ◽

pp. 564-568 ◽

Cited By ~ 1

Author(s):

Qin Rao ◽

Isaiah Schuster ◽

Talal Seoud ◽

Kevin Zarrabi ◽

Nirvani Goolsarran

Keyword(s):

Liver Injury ◽

Liver Function ◽

Liver Failure ◽

Acute Liver Injury ◽

Early Recognition ◽

Antibiotic Use ◽

Liver Function Tests ◽

The United States ◽

Drug Induced ◽

Drug Induced Liver Injury

Nafcillin-induced acute liver injury is a rare and potentially fatal complication that has been known since the 1960s but inadequately studied. At this time, the only proven treatment is early discontinuation of the drug. Because of the high prevalence of nafcillin class antibiotic use in the United States, it is important for clinicians to have a high clinical suspicion for this diagnosis. We present a case of liver failure attributable to nafcillin use in a 68-year-old male with a history methicillin-sensitive Staphylococcus and L3/L4 osteomyelitis. After starting long-term antibiotic therapy, he presented with painless jaundice which necessitated discontinuation of the drug. At the time of presentation, the patient’s lab work exhibited a bilirubin/direct bilirubin of 9.4/8.2 mg/dL, alkaline phosphatase of 311 IU/L, and aspartate transaminase/alanine transaminase of 109/127 IU/L. The patient was switched to i.v. vancomycin given the concern for drug-induced liver injury. Imaging did not show obstruction of the hepatobiliary or pancreaticobiliary trees. Serology was unremarkable for viral etiology, autoimmune processes, Wilson disease, and hemochromatosis. A liver biopsy showed findings consistent with drug-induced liver injury. The patient’s liver function tests peaked at day 7 of admission and trended towards normal levels with cessation of nafcillin therapy. The patient was discharged with a diagnosis of nafcillin-induced acute liver injury. Our case highlights the importance of early recognition of the diagnosis and careful monitoring of liver function when nafcillin is employed in the clinical setting.

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