We investigated the trends in listing and outcomes of drug-induced acute liver failure (DIALF) over the last quarter century in the United States using the United Network for Organ Sharing (UNOS) database. We examined waitlisted patients in the UNOS database between 1995 and 2020 with a diagnosis of DIALF and assessed trends in etiologies, demographic and clinical characteristics, and outcomes over 3 periods: 1995-2003, 2004-2012, and 2013-2020. Patients with DIALF and cirrhosis were classified as drug-induced acute-on-chronic liver failure. Implicated agents including acetaminophen (APAP) and herbal or dietary supplements (HDSs) were ascertained. There were 2146 individuals with DIALF during the study period. The observed demographic trends between the earliest and latest period included fewer pediatric patients (18.8% to 13.5%) but with an increasing number of males in non-APAP DIALF (31.8% to 41.4%) and increased racial diversity in APAP DIALF. Antimicrobials remained the most common non-APAP agents across all periods, but antiepileptics, propylthiouracil, and mushroom poisoning decreased, while HDSs markedly increased from 2.9% to 24.1% of all non-APAP DIALF patients. The overall 5-year post-liver transplantation (LT) patient survival improved significantly over the 3 periods (69.9% to 77.4% to 83.3%) and was evident for both APAP and non-APAP DIALF. Over the last quarter century, there has been an 8-fold increase in HDS-related liver failure necessitating waitlisting for liver transplantation in the United States. There are other important temporal trends during the study period, including improved survival following LT among both APAP and non-APAP DIALF patients.

中文翻译：

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在过去的 25 年里，美国与膳食补充剂相关的肝功能衰竭导致移植等候名单增加了八倍

我们使用器官共享联合网络 (UNOS) 数据库调查了过去 25 年美国药物性急性肝衰竭 (DIALF) 的列表和结果趋势。我们检查了 UNOS 数据库中 1995 年至 2020 年间被诊断为 DIALF 的候补患者，并评估了 3 个时期的病因、人口统计学和临床​​特征以及结果的趋势：1995-2003 年、2004-2012 年和 2013-2020 年。DIALF和肝硬化患者被归类为药物引起的慢加急性肝衰竭。确定了涉及的药物包括对乙酰氨基酚 (APAP) 和草药或膳食补充剂 (HDS)。在研究期间，有 2146 人患有 DIALF。观察到的最早和最晚时期之间的人口统计趋势包括较少的儿科患者（18.8% 至 13. 5%），但非 APAP DIALF 的男性人数增加（31.8% 至 41.4%），并且 APAP DIALF 的种族多样性增加。在所有时期，抗菌药物仍然是最常见的非 APAP 药物，但抗癫痫药、丙基硫氧嘧啶和蘑菇中毒减少，而 HDS 在所有非 APAP DIALF 患者中从 2.9% 显着增加至 24.1%。肝移植后 (LT) 患者的总体 5 年生存率在 3 个时期内显着改善（69.9% 至 77.4% 至 83.3%），并且对于 APAP 和非 APAP DIALF 来说都是明显的。在过去的 25 年中，与 HDS 相关的肝功能衰竭增加了 8 倍，需要在美国等待肝移植。在研究期间还有其他重要的时间趋势，包括 APAP 和非 APAP DIALF 患者的 LT 后生存率提高。