Objective: To evaluate the role of liver transplantation after paracetamol overdose.
Design: Prospective study of consecutive candidates for transplantation and performance of transplantation over 18 months.
Setting: Liver unit, King's College Hospital, London.
Main outcome measures: Fulfilment of indicators of poor prognosis, selection for transplantation, transplantation, survival.
Results: 30 of 37 patients considered to have a reasonable prognosis with intensive medical care survived. Of 14 of 29 patients considered to have a very poor prognosis and registered for urgent liver transplantation, six received liver transplants, four of whom survived, while seven died and one survived without a transplant. Three of 15 patients with poor prognostic indicators but not selected for transplantation survived.
Conclusion: Liver transplantation will have a definite but limited role in the management of fulminant hepatic failure induced by paracetamol.