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Liver transplant for paracetamol overdose is more common in Ireland and the UK than several other European countries

Ireland and the UK have significantly higher rates of paracetamol overdose causing acute liver failure leading to registration for transplantation (ALFT) compared to other European countries. In the image, a team of doctors in the operating room

Source: Ververidis Vasilis /

Of 114 cases of overdose-related acute liver failure that resulted in registration for transplantation, 111 cases (97%) were linked to paracetamol

Ireland and the UK have higher rates of paracetamol overdose that results in acute liver failure leading to registration for transplantation (ALFT) compared with several other European countries, according to the results of the SALT study published in the British Journal of Clinical Pharmacology[1].

The SALT study identified 600 ALFT cases, of which 114 cases were overdose related, at 52 liver transplant centres in seven European countries — France, Greece, Ireland, Italy, the Netherlands, Portugal and the UK — between 2005 and 2007. Of the 114 cases that involved overdose, 111 cases (97%) were linked to paracetamol.

On average, one case of paracetamol overdose resulting in ALFT occurred for each 167 tonnes of paracetamol sold. But the risk varied markedly between countries, with one ALFT event for every 20.7 tonnes of paracetamol sold in Ireland up to one in every 1,074 tonnes sold in Italy, a 50-fold difference.

Both Ireland and the UK had a significantly greater relative risk of overdose-related ALFT per tonne of paracetamol sold, with 8.07 and 1.67 times more cases in Ireland and the UK, respectively, compared with all countries pooled.

Per-population rates of overdose-related ALFT also varied significantly; the highest rate was for Ireland at one case in 286,000 inhabitants per year to lows for Greece and Portugal, which had no cases per 10 million inhabitants over three years, and Italy, which had one case per 60 million inhabitants over three years.

“The reasons for these differences are uncertain but could give indications for their prevention,” conclude the researchers.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20068678

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