Outcomes After Listing for Liver Transplant in Patients With Acute-on-Chronic Liver Failure: The Multicenter North American Consortium for the Study of End-Stage Liver Disease Experience

Jacqueline G. O’Leary, Jasmohan S. Bajaj, Puneeta Tandon, Scott W. Biggins, Florence Wong, Patrick Sequeira Kamath, Guadalupe Garcia-Tsao, Benedict Maliakkal, Jennifer Lai, Michael Fallon, Hugo E Vargas, Paul Thuluvath, Ram Subramanian, Leroy R. Thacker, K. Rajender Reddy

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Acute-on-chronic liver failure (ACLF) characterized with ≥2 extrahepatic organ failures in cirrhosis carries a high mortality. Outcomes of patients listed for liver transplantation (LT) after ACLF and after LT are largely unknown. The North American Consortium for the Study of End-Stage Liver Disease prospectively enrolled 2793 nonelectively hospitalized patients with cirrhosis; 768 were listed for LT. Within 3 months, 265 (35%) received a LT, 395 remained alive without LT, and 108 died/delisted. Compared with nonlisted patients, those listed were younger and more often had ACLF, acute kidney injury, and a higher admission Model for End-Stage Liver Disease (MELD) score. ACLF was most common in patients who died/delisted, followed by those alive with and without LT respectively, (30%, 22%, and 7%, respectively; P < 0.001). At LT, median MELD was 27.9% and 70% were inpatients; median time from hospitalization to LT was 26 days. Post-LT survival at 6 months was unchanged between those with and without ACLF (93% each at 6 months). There was no difference in 3- and 6-month mean post-LT creatinine in those with and without ACLF, despite those with ACLF having a higher mean pre-LT creatinine and a higher rate of perioperative dialysis (61%). In conclusion, patients with and without ACLF had similar survival after transplant with excellent renal recovery in both groups.

Original languageEnglish (US)
Pages (from-to)571-579
Number of pages9
JournalLiver Transplantation
Volume25
Issue number4
DOIs
StatePublished - Apr 1 2019

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End Stage Liver Disease
Liver Transplantation
Transplants
Liver
Creatinine
Fibrosis
Acute-On-Chronic Liver Failure
Survival
Acute Kidney Injury
Inpatients
Dialysis
Hospitalization

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Outcomes After Listing for Liver Transplant in Patients With Acute-on-Chronic Liver Failure : The Multicenter North American Consortium for the Study of End-Stage Liver Disease Experience. / O’Leary, Jacqueline G.; Bajaj, Jasmohan S.; Tandon, Puneeta; Biggins, Scott W.; Wong, Florence; Kamath, Patrick Sequeira; Garcia-Tsao, Guadalupe; Maliakkal, Benedict; Lai, Jennifer; Fallon, Michael; Vargas, Hugo E; Thuluvath, Paul; Subramanian, Ram; Thacker, Leroy R.; Reddy, K. Rajender.

In: Liver Transplantation, Vol. 25, No. 4, 01.04.2019, p. 571-579.

Research output: Contribution to journalArticle

O’Leary, JG, Bajaj, JS, Tandon, P, Biggins, SW, Wong, F, Kamath, PS, Garcia-Tsao, G, Maliakkal, B, Lai, J, Fallon, M, Vargas, HE, Thuluvath, P, Subramanian, R, Thacker, LR & Reddy, KR 2019, 'Outcomes After Listing for Liver Transplant in Patients With Acute-on-Chronic Liver Failure: The Multicenter North American Consortium for the Study of End-Stage Liver Disease Experience', Liver Transplantation, vol. 25, no. 4, pp. 571-579. https://doi.org/10.1002/lt.25426
O’Leary, Jacqueline G. ; Bajaj, Jasmohan S. ; Tandon, Puneeta ; Biggins, Scott W. ; Wong, Florence ; Kamath, Patrick Sequeira ; Garcia-Tsao, Guadalupe ; Maliakkal, Benedict ; Lai, Jennifer ; Fallon, Michael ; Vargas, Hugo E ; Thuluvath, Paul ; Subramanian, Ram ; Thacker, Leroy R. ; Reddy, K. Rajender. / Outcomes After Listing for Liver Transplant in Patients With Acute-on-Chronic Liver Failure : The Multicenter North American Consortium for the Study of End-Stage Liver Disease Experience. In: Liver Transplantation. 2019 ; Vol. 25, No. 4. pp. 571-579.
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abstract = "Acute-on-chronic liver failure (ACLF) characterized with ≥2 extrahepatic organ failures in cirrhosis carries a high mortality. Outcomes of patients listed for liver transplantation (LT) after ACLF and after LT are largely unknown. The North American Consortium for the Study of End-Stage Liver Disease prospectively enrolled 2793 nonelectively hospitalized patients with cirrhosis; 768 were listed for LT. Within 3 months, 265 (35{\%}) received a LT, 395 remained alive without LT, and 108 died/delisted. Compared with nonlisted patients, those listed were younger and more often had ACLF, acute kidney injury, and a higher admission Model for End-Stage Liver Disease (MELD) score. ACLF was most common in patients who died/delisted, followed by those alive with and without LT respectively, (30{\%}, 22{\%}, and 7{\%}, respectively; P < 0.001). At LT, median MELD was 27.9{\%} and 70{\%} were inpatients; median time from hospitalization to LT was 26 days. Post-LT survival at 6 months was unchanged between those with and without ACLF (93{\%} each at 6 months). There was no difference in 3- and 6-month mean post-LT creatinine in those with and without ACLF, despite those with ACLF having a higher mean pre-LT creatinine and a higher rate of perioperative dialysis (61{\%}). In conclusion, patients with and without ACLF had similar survival after transplant with excellent renal recovery in both groups.",
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AU - Bajaj, Jasmohan S.

AU - Tandon, Puneeta

AU - Biggins, Scott W.

AU - Wong, Florence

AU - Kamath, Patrick Sequeira

AU - Garcia-Tsao, Guadalupe

AU - Maliakkal, Benedict

AU - Lai, Jennifer

AU - Fallon, Michael

AU - Vargas, Hugo E

AU - Thuluvath, Paul

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N2 - Acute-on-chronic liver failure (ACLF) characterized with ≥2 extrahepatic organ failures in cirrhosis carries a high mortality. Outcomes of patients listed for liver transplantation (LT) after ACLF and after LT are largely unknown. The North American Consortium for the Study of End-Stage Liver Disease prospectively enrolled 2793 nonelectively hospitalized patients with cirrhosis; 768 were listed for LT. Within 3 months, 265 (35%) received a LT, 395 remained alive without LT, and 108 died/delisted. Compared with nonlisted patients, those listed were younger and more often had ACLF, acute kidney injury, and a higher admission Model for End-Stage Liver Disease (MELD) score. ACLF was most common in patients who died/delisted, followed by those alive with and without LT respectively, (30%, 22%, and 7%, respectively; P < 0.001). At LT, median MELD was 27.9% and 70% were inpatients; median time from hospitalization to LT was 26 days. Post-LT survival at 6 months was unchanged between those with and without ACLF (93% each at 6 months). There was no difference in 3- and 6-month mean post-LT creatinine in those with and without ACLF, despite those with ACLF having a higher mean pre-LT creatinine and a higher rate of perioperative dialysis (61%). In conclusion, patients with and without ACLF had similar survival after transplant with excellent renal recovery in both groups.

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