Systematic review with meta-analysis: liver transplant provides survival benefit in patients with acute on chronic liver failure.

Autor: Abdallah MA; Department of Medicine, University of SD Sanford School of Medicine, Sioux Falls, SD, USA., Waleed M; Department of Medicine, University of SD Sanford School of Medicine, Sioux Falls, SD, USA., Bell MG; Department of Medicine, University of SD Sanford School of Medicine, Sioux Falls, SD, USA., Nelson M; Department of Medicine, University of SD Sanford School of Medicine, Sioux Falls, SD, USA., Wong R; Division of Gastroenterology and Hepatology, Alameda Health System Highland Hospital, Oakland, CA, USA., Sundaram V; Department of Medicine and Comprehensive Transplant Center, Cedar-Sinai Medical Center, Los Angeles, CA, USA., Singal AK; Department of Medicine, University of SD Sanford School of Medicine, Sioux Falls, SD, USA.; Division of Transplant Hepatology, Avera Transplant Institute, Sioux Falls, SD, USA.
Jazyk: angličtina
Zdroj: Alimentary pharmacology & therapeutics [Aliment Pharmacol Ther] 2020 Jul; Vol. 52 (2), pp. 222-232. Date of Electronic Publication: 2020 Jun 03.
DOI: 10.1111/apt.15793
Abstrakt: Background: Data on liver transplantation (LT) in acute on chronic liver failure (ACLF) are scanty.
Aim: To perform meta-analysis on outcomes after LT for ACLF compared with ACLF patients not receiving LT or with LT recipients for indications other than ACLF.
Methods: We pooled data from 12 studies on LT outcomes among ACLF patients.
Results: Among nine studies, 22 238 LT recipients for ACLF vs 30 791 for non-ACLF were younger by 1.1 years, less males (64% vs 66.4%), and higher model for end-stage disease score by 14.5 (14.4-14.6), P < 0.01 for all. Post-transplant patient survival at 30 day, 90 day, 6 months, 1 year and 5 years was lower in ACLF: 96.2% vs 98.1%, 92.6% vs 96.2%, 89.9% vs 94.4%, 86.0% vs 91.9%, 66.9% vs 80.7% respectively, P < 0.01 for all. ACLF patients stayed longer in hospital and ICU by 5.7 and 10.5 days respectively, P < 0.001, with similar post-transplant complications [74.4% vs 55.5%, P = 0.12]. Among three studies, 441 LT recipients for ACLF vs 301 ACLF patients not selected for LT had better 30 day and 1 year survival: 95.2% vs 60% and 85.3% vs 28.2% respectively, P < 0.001. Outcomes were worse in ACLF-3 and better for ACLF-1 and ACLF-2 patients at the time of LT.
Conclusion: In this pooled analysis with a large sample size across the globe, LT for select patients with ACLF provided survival benefit. However, larger prospective studies are needed to further refine selection criteria, especially for ACLF-3 patients as basis for improving outcomes and optimal utilisation of scarce donor pool.
(© 2020 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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