Acute liver failure in Spain: analysis of 267 cases

Liver Transpl. 2007 Oct;13(10):1389-95. doi: 10.1002/lt.21119.


The cause of acute liver failure (ALF) is a major determinant of its outcome. Acetaminophen (paracetamol) overdose is a leading cause of ALF in some developed countries, whereas in others, such as Spain, it is extremely rare. To analyze the etiology, characteristics, and outcome of ALF in Spain, we performed a retrospective analysis of 267 patients whom we observed from 1992 to 2000. Seventeen tertiary-care hospitals with active liver transplantation (LT) programs contributed data. Causes of ALF were viral hepatitis in 98 (37%; hepatitis B virus in 75 patients), unknown in 86 (32%), drug or toxic reactions in 52 (19.5%; acetaminophen overdose in 6), and miscellaneous in 31 (11.6%). Overall survival was 58%. LT was performed in 150 patients, with a survival of 69%. Despite fulfilling criteria, 51 patients were not transplanted because of contraindications; their survival was only 7.8%. Forty-seven (85.5%) of 55 patients without transplant criteria survived. Hepatitis B virus is the most common cause of ALF in Spain, although the origin of 30% of cases remains undetermined. Acetaminophen overdose represents a very rare cause of ALF. LT was performed in >50% of cases. Patients without transplant criteria had a very good prognosis; those who fulfilled these criteria but who had contraindications for transplantation had a high mortality rate.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Chemical and Drug Induced Liver Injury / complications
  • Chemical and Drug Induced Liver Injury / epidemiology
  • Child
  • Child, Preschool
  • Female
  • Hepatitis, Viral, Human / complications
  • Hepatitis, Viral, Human / epidemiology
  • Humans
  • Incidence
  • Infant
  • Liver Failure, Acute / epidemiology*
  • Liver Failure, Acute / etiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Sex Distribution
  • Spain / epidemiology
  • Surveys and Questionnaires
  • Survival Rate