Long-term outcomes of emergency liver transplantation for acute liver failure.

Abstract

Acute liver failure continues to be associated with a high mortality rate, and emergency liver transplantation is often the only life-saving treatment. The short-term outcomes are decidedly worse in comparison with those for nonurgent cases, whereas the long-term results have not been reported as extensively. We report our center's experience with urgent liver transplantation, long-term survival, and major complications. From 1994 to 2007, 60 patients had emergency liver transplantation for acute liver failure. The waiting list mortality rate was 6%. The mean waiting time was 2.7 days. Post-transplantation, the perioperative mortality rate was 15%, and complications included neurological problems (13%), biliary problems (10%), and hepatic artery thrombosis (5%). The 5- and 10-year patient survival rates were 76% and 69%, respectively, and the graft survival rates were 65% and 59%. Recipients of blood group-incompatible grafts had an 83% retransplantation rate. Univariate analysis by Cox regression analysis found that cerebral edema and extended criteria donor grafts were associated with worse long-term survival. Severe cerebral edema on a computed tomography scan pre-transplant was associated with either early mortality or permanent neurological deficits. The keys to long-term success and continued progress in urgent liver transplantation are the use of good-quality whole grafts and a short waiting list time, both of which depend on access to a sufficient pool of organ donors. Severe preoperative cerebral edema should be a relative contraindication to transplantation.

• Authors: Gabriel Chan, Ali Taqi, Paul Marotta, Mark Levstik, Vivian McAlister, William Wall, Douglas Quan
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 15 Issue 12 Pg. 1696-702 (Dec 2009) ISSN: 1527-6473 [Electronic] United States
• PMID: 19938124 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Brain Edema (complications)
• Contraindications
• Emergency Treatment
• Female
• Humans
• Kaplan-Meier Estimate
• Liver Failure, Acute (etiology, mortality, surgery)
• Liver Transplantation (adverse effects, mortality)
• Male
• Middle Aged
• Nervous System Diseases (etiology)
• Ontario (epidemiology)
• Patient Selection
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Survivors (statistics & numerical data)
• Time Factors
• Tissue Donors (supply & distribution)
• Treatment Outcome
• Waiting Lists
• Young Adult