Changing Patterns of Causation and the Use of Transplantation in the United Kingdom

William Bernal

doi:10.1055/s-2003-42640

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2003; 23(3): 227-238
DOI: 10.1055/s-2003-42640

Changing Patterns of Causation and the Use of Transplantation in the United Kingdom

William Bernal

Consultant in Intensive Care Medicine Liver Intensive Therapy Unit Institute of Liver Studies King's College Hospital London,United Kingdom

Abstract

ABSTRACT

Acute liver failure (ALF) is a rare condition in the United Kingdom. Comprehensive supportive intensive care of extra-hepatic organ failure and the early recognition of and use of transplantation for those who will not survive form the cornerstone of its management. Over the last 30 years there has been a reduction in the proportion of cases resulting from viral and seronegative hepatitis, and a progressive rise in those resulting from severe acetaminophen-induced hepatotoxicity. The latter cases mostly result from deliberate self-poisoning and formed the major cause of ALF hospital admissions and indication for emergency liver transplantation. The increasing misuse of acetaminophen has paralleled a rise in sales and greater availability of the drug. Introduction of legislation to restrict sales of acetaminophen has been followed by a fall in hospital admissions resulting from self-poisoning, a 20% reduction in deaths, and a 50% fall in the number of patients undergoing emergency liver transplantation. The reduction in acetaminophen-related ALF has been paralleled by an increase in the number of transplants performed in ALF of nonacetaminophen etiologies.

KEYWORDS

Acute liver failure - acetaminophen - self-poisoning - transplantation - hepatotoxicity

Full Text

References

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