TY - JOUR
T1 - Outcomes After Listing for Liver Transplant in Patients With Acute-on-Chronic Liver Failure
T2 - The Multicenter North American Consortium for the Study of End-Stage Liver Disease Experience
AU - O’Leary, Jacqueline G.
AU - Bajaj, Jasmohan S.
AU - Tandon, Puneeta
AU - Biggins, Scott W.
AU - Wong, Florence
AU - Kamath, Patrick S.
AU - Garcia-Tsao, Guadalupe
AU - Maliakkal, Benedict
AU - Lai, Jennifer
AU - Fallon, Michael
AU - Vargas, Hugo E.
AU - Thuluvath, Paul
AU - Subramanian, Ram
AU - Thacker, Leroy R.
AU - Reddy, K. Rajender
N1 - Publisher Copyright:
Copyright © 2019 by the American Association for the Study of Liver Diseases.
PY - 2019/4
Y1 - 2019/4
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.
AB - 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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U2 - 10.1002/lt.25426
DO - 10.1002/lt.25426
M3 - Article
C2 - 30724010
AN - SCOPUS:85063327794
SN - 1527-6465
VL - 25
SP - 571
EP - 579
JO - Liver Transplantation
JF - Liver Transplantation
IS - 4
ER -