Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study

Liver Int. 2015 Feb;35(2):370-80. doi: 10.1111/liv.12632. Epub 2014 Jul 28.


Background & aims: The long-term clinical outcomes in initial survivors with acute liver failure (ALF) are not well known. The aim of this study was to provide an overview of the 2-year clinical outcomes among initial survivors and liver transplant (LT) recipients that were alive 3 weeks after enrolment in the Acute Liver Failure Study Group (ALFSG).

Methods: Outcomes in adult ALFSG patients that were enrolled between 1998 and 2010 were reviewed.

Results: Two-year patient survival was significantly higher in the 262 LT recipients (92.4%) compared to the 306 acetaminophen (APAP) spontaneous survivors (SS) (89.5%) and 200 non-APAP SS (75.5%) (P < 0.0001). The causes of death were similar in the three groups but the time to death was significantly longer in the LT recipients (P < 0.0001). Independent predictors of 2-year mortality in the APAP group were a high serum phosphate level and patient age (c-statistic = 0.65 (0.54, 0.76)), patient age and days from jaundice to ALF onset in the non-APAP group (c-statistic = 0.69 (0.60, 0.78)), and patient age, days from jaundice, and higher coma grade in the LT recipients (c-statistic = 0.74 (0.61, 0.87)). The LT recipients were significantly more likely to be employed and have a higher educational level (P < 0.05).

Conclusions: Two-year outcomes in initial survivors of ALF are generally good but non-APAP patients have a significantly lower survival which may relate to pre-existing medical comorbidities. Spontaneous survivors with APAP overdose experience substantial morbidity during follow-up from ongoing psychiatric and substance abuse issues.

Keywords: age; cerebral oedema; liver transplantation; prognosis; regeneration.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen / therapeutic use*
  • Adult
  • Female
  • Follow-Up Studies
  • Humans
  • Liver Failure, Acute / drug therapy
  • Liver Failure, Acute / epidemiology*
  • Liver Failure, Acute / surgery
  • Liver Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • Prospective Studies
  • Statistics, Nonparametric
  • Survivors / statistics & numerical data*
  • Transplant Recipients / statistics & numerical data*
  • Treatment Outcome


  • Acetaminophen