Liver transplantation after paracetamol overdose.

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.