Liver Transplantation for Acetaminophen-Induced Acute Liver Failure: Role of Psychiatric Comorbidity in Listing Decisions and Outcomes

  • Okeefe L. Simmons
  • Caitlyn Meinzer
  • Jody Rule
  • William M. LeeEmail author
  • for the Acute Liver Failure Study Group
Original Article



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.


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.


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].


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.


Liver failure Acute Liver transplantation Acetaminophen Psychiatric diagnosis 



Acute liver failure


Acute Liver Failure Study Group


Acetaminophen (N-acetyl-p-aminophenol)


Intracranial pressure monitoring


Liver transplantation




Spontaneous survival



This study was supported by the National Institute of Diabetes, Digestive and Kidney Diseases, U-01 DK 58369 to UT Southwestern Medical Center. Additional support was provided by the George A Roberts Fund in the Southwestern Medical Foundation.

Compliance with Ethical Standards

Conflict of interest

The authors report no conflicts of interest pertinent to this manuscript.

Supplementary material

10620_2019_5901_MOESM1_ESM.docx (55 kb)
Supplementary material 1 (DOCX 54 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Digestive and Liver Diseases, Department of Internal MedicineUniversity of Texas Southwestern Medical Center at DallasDallasUSA
  2. 2.Department of Public Health SciencesMedical University of South CarolinaCharlestonUSA
  3. 3.Division of Gastrointestinal and Liver DiseasesLos Angeles County + University of Southern California Medical CenterLos AngelesUSA

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