Predictors and outcome of emergent Liver transplantation for patients with acute-on-chronic liver failure.

Abstract

BACKGROUND AND AIMS:

Controversy exists over whether emergent liver transplantation (LT) should be performed for patients with acute-on-chronic liver failure (ACLF), especially for patients with multiple organ failure.

METHODS:

A total of 110 ACLF patients, defined by the European Association for the Study of the Liver (EASL) Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) criteria were analyzed. The primary outcome was overall survival after ACLF diagnosis.

RESULTS:

During follow-up, 76 patients received LT (59 received deceased-donor LT and 17 patients received living-donor LT). The overall survival was better for patients who received LT than patients who did not (82.9% vs. 17.6%, P < 0.001). Among the 76 patients who received LT, the overall survival was not different according to ACLF grade at diagnosis (70.0%, 85.3%, and 84.4% at one-year for ACLF grades 1, 2, and 3, respectively, P = 0.45). The baseline model for end-stage liver disease (MELD) score and progression of the ACLF grade during the pre-transplant period were independent factors for survival after LT. The one-year survival rate was 92.3% for patients with baseline MELD scores of ≤ 32 without ACLF grade progression, whereas it was 33.3% for those with baseline MELD scores of > 32 and ACLF grade progression.

CONCLUSIONS:

Emergent LT provided a significant survival benefit to ACLF patients, regardless of the baseline ACLF grade. Post-LT outcomes were associated with baseline MELD scores and ACLF progression during the pre-transplant period, which might be used in the emergent LT plan for patients presenting with ACLF.

• Authors: Ji Eun Kim, Dong Hyun Sinn, Gyu-Seong Choi, Jong Man Kim, Jae-Won Joh, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 53 Issue 8 Pg. 1004-1010 (Aug 2021) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 33931340 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Biomarkers

Topics

• Acute-On-Chronic Liver Failure (diagnosis, mortality, surgery)
• Biomarkers (analysis)
• Emergencies
• Female
• Humans
• Liver Transplantation (mortality)
• Male
• Middle Aged
• Multiple Organ Failure (diagnosis, mortality, surgery)
• Predictive Value of Tests
• Preoperative Period
• Prognosis
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Survival Rate
• Treatment Outcome
• Waiting Lists