'First week' is the crucial period for deciding living donor liver transplantation in patients with acute-on-chronic liver failure.

Autor: Choudhury A; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.; Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India., Vijayaraghavan R; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.; Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India., Maiwall R; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.; Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India., Kumar M; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.; Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India., Duan Z; Translational Hepatology Institute Capital Medical University, Beijing You'an Hospital, Beijing, China., Yu C; Translational Hepatology Institute Capital Medical University, Beijing You'an Hospital, Beijing, China., Hamid SS; Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan., Jafri W; Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan., Butt AS; Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan., Devarbhavi H; Department of Gastroenterology and Hepatology, St John Medical College, Bangalore, India., Ning Q; Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China., Ma K; Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China., Tan SS; Department of Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia., Shukla A; Department of Hepatology, KEM Hospital and Seth GSMC, Mumbai, India., Dhiman R; Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India., Duseja A; Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India., Taneja S; Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India., Eapen CE; Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India., Goel A; Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India., Treeprasertsuk S; Department of Medicine, Chulalongkorn University, Bangkok, Thailand., Al-Mahtab M; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh., Ghazinyan H; Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia., Kim DJ; Centre for Liver and Digestive Diseases, Gangwon-Do, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea., Sahu MK; Department of Gastroenterology and Biliary Sciences, IMS and SUM Hospital, Bhubaneswar, Odisha, India., Lee GH; Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore., Lesmana LA; Department of Medicine, Medistra Hospital, Jakarta, Indonesia., Lesmana RC; Department of Medicine, Medistra Hospital, Jakarta, Indonesia., Shah S; Department of Hepatology, Global Hospital, Mumbai, India., Abbas Z; Department of Hepatogastroenterology, Ziauddin University, Karachi, Pakistan., Sollano JD; Department of Hepatology, Cardinal Santos Medical Centre, Manila, Philippines., Rao PN; Asian Institute of Gastroenterology, Hyderabad, India., Kulkarni A; Asian Institute of Gastroenterology, Hyderabad, India., Shiha G; Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt., Shrestha A; Liver Foundation Nepal Sitapaila Height, Kathmandu, Nepal., Dokmeci A; Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey., Yuen MF; Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China., Payawal DA; Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines., Kalista KF; Division of Hepatobiliary Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia., Prasad VGM; Department of Gastroenterology, VGM Hospital, Coimbatore, India., Lau GK; Department of Gastroenterology, Humanity and Health Medical Centre, Hong Kong, China., Karim F; Department of Hepatology, Sir Salimullah Medical College, Dhaka, Bangladesh., Jain P; Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India., Kumar G; Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India., Arora V; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.; Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India., Pamecha V; Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.; Department of Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India., Sinha P; Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.; Department of Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India., Sarin SK; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com.; Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India. shivsarin@gmail.com.
Jazyk: angličtina
Zdroj: Hepatology international [Hepatol Int] 2021 Dec; Vol. 15 (6), pp. 1376-1388. Date of Electronic Publication: 2021 Oct 04.
DOI: 10.1007/s12072-021-10206-6
Abstrakt: Background and Aims: Acute-on-chronic liver failure (ACLF) is a rapidly progressive illness with high short-term mortality. Timely liver transplant (LT) may improve survival. We evaluated various indices for assessment of the severity of liver failure and their application for eligibility and timing of living donor LT (LDLT).
Methods: Altogether 1021 patients were analyzed for the severity and organ failure at admission to determine transplant eligibility and 28 day survival with or without transplant.
Results: The ACLF cohort [mean age 44 ± 12.2 years, males 81%) was of sick patients; 55% willing for LT at admission, though 63% of them were ineligible due to sepsis or organ failure. On day 4, recovery in sepsis and/or organ failure led to an improvement in transplant eligibility from 37% at baseline to 63.7%. Delay in LT up to 7 days led to a higher incidence of multiorgan failure (p < 0.01) contributing to 23% of the first week and 55% of all-cause 28-day mortality. In a matched cohort analysis, the actuarial survival with LT (n = 41) and conditional survival in the absence of transplant (n = 191) were comparable, when the condition, i.e., transplant was adjusted. The comparison curve showed differentiation in survival beyond 7 days (p < 0.01).
Conclusions: ACLF is a rapidly progressive disease and risk stratification within the first week of hospitalization is needed. 'Emergent LT' should be defined in the first week in the ACLF patients; the transplant window for improving survival in a live donor setting.
(© 2021. Asian Pacific Association for the Study of the Liver.)
Databáze: MEDLINE
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