Liver transplantation for critically ill cirrhotic patients: Stratifying utility based on pretransplant factors.

Autor: Artzner T; Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France., Michard B; Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.; Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France., Weiss E; Département Anesthésie et Réanimation, AP-HP, Hôpital Beaujon, Clichy, France.; UMR S 1149 Inserm/Université Paris Diderot, Paris, France., Barbier L; Service de Chirurgie Digestive et Transplantation Hépatique, CHU Trousseau, Université de Tours, Tours, France.; FHU SUPORT (Fédération Hospitalo-Universitaire SUrvival oPtimization in ORgan Transplantation), Strasbourg, France., Noorah Z; Service d'Anesthésie et Réanimation Chirurgicale, Hôpital Henri Mondor, Créteil, France., Merle JC; Service d'Anesthésie et Réanimation Chirurgicale, Hôpital Henri Mondor, Créteil, France., Paugam-Burtz C; Département Anesthésie et Réanimation, AP-HP, Hôpital Beaujon, Clichy, France.; UMR S 1149 Inserm/Université Paris Diderot, Paris, France., Francoz C; UMR S 1149 Inserm/Université Paris Diderot, Paris, France.; Département d'Hépatologie, AP-HP Hôpital Beaujon, Clichy, France., Durand F; UMR S 1149 Inserm/Université Paris Diderot, Paris, France.; Département d'Hépatologie, AP-HP Hôpital Beaujon, Clichy, France., Soubrane O; UMR S 1149 Inserm/Université Paris Diderot, Paris, France.; Service de Chirurgie Hépato-Pancréato-Biliaire, AP-HP Hôpital Beaujon, Clichy, France., Pirani T; Institute of Liver Studies, King's College Hospital, London, UK., Theocharidou E; Institute of Liver Studies, King's College Hospital, London, UK., O'Grady J; Institute of Liver Studies, King's College Hospital, London, UK., Bernal W; Institute of Liver Studies, King's College Hospital, London, UK., Heaton N; Institute of Liver Studies, King's College Hospital, London, UK., Salamé E; Service de Chirurgie Digestive et Transplantation Hépatique, CHU Trousseau, Université de Tours, Tours, France.; FHU SUPORT (Fédération Hospitalo-Universitaire SUrvival oPtimization in ORgan Transplantation), Strasbourg, France., Bucur P; Service de Chirurgie Digestive et Transplantation Hépatique, CHU Trousseau, Université de Tours, Tours, France.; FHU SUPORT (Fédération Hospitalo-Universitaire SUrvival oPtimization in ORgan Transplantation), Strasbourg, France., Barraud H; FHU SUPORT (Fédération Hospitalo-Universitaire SUrvival oPtimization in ORgan Transplantation), Strasbourg, France.; Service d'Hépatologie, CHU Trousseau, Université de Tours, France., Lefebvre F; Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France., Serfaty L; Service d'Hépato-Gastro-Entérologie et d'Assistance Nutritive, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France., Besch C; Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France., Bachellier P; Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France., Schneider F; Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.; UMR S 1121 Inserm/Université de Strasbourg, Strasbourg, France., Levesque E; Service d'Anesthésie et Réanimation Chirurgicale, Hôpital Henri Mondor, Créteil, France., Faitot F; Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.; Laboratoire ICube, UMR 7357, Université de Strasbourg, Strasbourg, France.
Jazyk: angličtina
Zdroj: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2020 Sep; Vol. 20 (9), pp. 2437-2448. Date of Electronic Publication: 2020 Apr 15.
DOI: 10.1111/ajt.15852
Abstrakt: The aim of this study was to produce a prognostic model to help predict posttransplant survival in patients transplanted with grade-3 acute-on-chronic liver failure (ACLF-3). Patients with ACLF-3 who underwent liver transplantation (LT) between 2007 and 2017 in 5 transplant centers were included (n = 152). Predictors of 1-year mortality were retrospectively screened and tested on a single center training cohort and subsequently tested on an independent multicenter cohort composed of the 4 other centers. Four independent pretransplant risk factors were associated with 1-year mortality after transplantation in the training cohort: age ≥53 years (P = .044), pre-LT arterial lactate level ≥4 mml/L (P = .013), mechanical ventilation with PaO 2 /FiO 2  ≤ 200 mm Hg (P = .026), and pre-LT leukocyte count ≤10 G/L (P = .004). A simplified version of the model was derived by assigning 1 point to each risk factor: the transplantation for Aclf-3 model (TAM) score. A cut-off at 2 points distinguished a high-risk group (score >2) from a low-risk group (score ≤2) with 1-year survival of 8.3% vs 83.9% respectively (P < .001). This model was subsequently validated in the independent multicenter cohort. The TAM score can help stratify posttransplant survival and identify an optimal transplantation window for patients with ACLF-3.
(© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)
Databáze: MEDLINE
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