Okeefe L Simmons1,2, Caitlyn Meinzer3, Jody Rule1, William M Lee4. 1. Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 5959 Harry Hines Blvd. Ste 420, Dallas, TX, 75390-8887, USA. 2. Division of Gastrointestinal and Liver Diseases, Los Angeles County + University of Southern California Medical Center, Diagnostic and Treatment Building, 1983 Marengo Street, Room B4H100, Los Angeles, CA, 90033, USA. 3. Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, Charleston, SC, 29425, USA. 4. Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 5959 Harry Hines Blvd. Ste 420, Dallas, TX, 75390-8887, USA. William.lee@utsouthwestern.edu.
Abstract
BACKGROUND: Psychiatric co-morbidities are thought to deter listing of patients with acetaminophen-induced acute liver failure (APAP-ALF) for liver transplantation (LT). We examined the listing process and short-term outcomes via a cohort study of APAP-ALF patients with and without psychiatric comorbidity. METHODS: We analyzed listing determinants, listing rates, and short-term (21-day) outcomes in APAP-ALF patients with and without psychiatric comorbidity (mental illness and/or substance abuse) enrolled in the ALFSG registry between 2000 and 2016. RESULTS: Of the 910 APAP-ALF patients, 801 (88%) had evidence of psychiatric comorbidity. There was no difference in listing between patients with (169/801, 21%) and without (26/109, 24%) psychiatric comorbidity (p = 0.59). Listed patients in both groups were younger with more severe admission clinical parameters than those not listed. Patients with and without psychiatric comorbidity had similar short-term outcomes: transplant rates among listed patients [57/169 (34%) vs 10/26 (39%), p = 0.80], spontaneous (transplant-free) survival (SS) [544/801 (68%) vs 73/109 (67%), p = 0.93], and overall death [207/801 (26%) vs 26/109 (24%), p = 0.74]. CONCLUSIONS: In our study, which is limited by informal psychiatric assessments, psychiatric comorbidity in APAP-ALF patients does not appear to impact listing, or short-term outcomes-SS, LT, or death. Transplant listing decisions primarily appear to be based on clinical severity of disease, rather than concern that APAP-ALF patients' psychiatric comorbidity will compromise outcomes.
BACKGROUND:Psychiatric co-morbidities are thought to deter listing of patients with acetaminophen-induced acute liver failure (APAP-ALF) for liver transplantation (LT). We examined the listing process and short-term outcomes via a cohort study of APAP-ALFpatients with and without psychiatric comorbidity. METHODS: We analyzed listing determinants, listing rates, and short-term (21-day) outcomes in APAP-ALFpatients with and without psychiatric comorbidity (mental illness and/or substance abuse) enrolled in the ALFSG registry between 2000 and 2016. RESULTS: Of the 910 APAP-ALFpatients, 801 (88%) had evidence of psychiatric comorbidity. There was no difference in listing between patients with (169/801, 21%) and without (26/109, 24%) psychiatric comorbidity (p = 0.59). Listed patients in both groups were younger with more severe admission clinical parameters than those not listed. Patients with and without psychiatric comorbidity had similar short-term outcomes: transplant rates among listed patients [57/169 (34%) vs 10/26 (39%), p = 0.80], spontaneous (transplant-free) survival (SS) [544/801 (68%) vs 73/109 (67%), p = 0.93], and overall death [207/801 (26%) vs 26/109 (24%), p = 0.74]. CONCLUSIONS: In our study, which is limited by informal psychiatric assessments, psychiatric comorbidity in APAP-ALFpatients does not appear to impact listing, or short-term outcomes-SS, LT, or death. Transplant listing decisions primarily appear to be based on clinical severity of disease, rather than concern that APAP-ALFpatients' psychiatric comorbidity will compromise outcomes.
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