U.S. Department of Health and Human Services

Improved outcomes and survival following acute liver failure in recent years

Results from a national, multi-center study spanning 16 years showed that outcomes and survival have improved for people who experience acute liver failure, including those who did and did not receive a liver transplant.  Acute liver failure occurs when severe liver injury takes place suddenly and without any signs of preexisting liver disease.  The leading causes of acute liver failure in the United States include damage from drugs, in particular from an overdose of acetaminophen, the drug found in many commonly used non-prescription and prescription pain relievers, or from liver diseases such as viral hepatitis or autoimmune hepatitis, though the cause is unknown in about 10 percent of cases.  Some people who experience acute liver failure require a liver transplant to improve their likelihood of survival.  Although the demand for liver transplants far exceeds supply, those who are able to be transplanted fare well, with a better chance of survival than those who do not receive a transplant. 

In the current study, researchers analyzed data collected since 1998 by the NIDDK-supported Acute Liver Failure Study Group, including more than 2000 women and men treated at 31 liver disease and transplant centers throughout the United States.  Data, including clinical features, treatments, and outcomes, from two 8-year periods—1998 to 2005 and 2006 to 2013—were collected and analyzed. They found that 3-week survival rates increased between the two 8-year periods, particularly for those who did not require or were not able to receive a liver transplant.  The analysis also revealed a reduced rate of requests for liver transplants and the lessened use of interventions such as blood transfusions or ventilators, but also increased use of vasopressor drugs to restore blood pressure, between these two time periods.  Therapeutic use of the drug N-acetyl-cysteine, typically used as a therapy for acetaminophen overdose, and increasingly used for other causes of acute liver failure as well, was also higher in the second period.  This study documents how outcomes and survival have improved in recent years for individuals who experience the life-threatening event of acute liver failure.  Further studies will be required to tease out which changes in medical practice, such as broader N-acetyl-cysteine use and improved intensive care, during these time periods may have led to these improvements.

Reuben A, Tillman H, Fontana RJ, Davern T, McGuire B, Stravitz RT, Durklaski V, Larson AM, Liou I, Fix O, Schilsky M, McCashland T, Hay JE, Murray N, Shaikh OS, Ganger D, Zaman A, Han SB, Chung RT, Smith A, Brown R, Crippin J, Harrison ME, Koch D, Munoz S, Reddy KR, Rossaro L, Satyanarayana R, Hassanein T, Hanje AJ, Olson J, Sumbramanian R, Karvellas C, Hameed B, Sherker AH, Robuck P, and Lee WM. Outcomes in adults with acute liver failure between 1998 and 2013: an observational cohort study. Ann Intern Med 164: 724-732, 2016.