Patient Selection for Living Donor Liver Transplantation in Acute-on-chronic Liver Failure.

Autor: Bhatti ABH; Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan.; Shifa Tameer-e-Millat University, Pakistan., Qasim SF; Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan., Zamrood Z; Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan., Riyaz S; Shifa Tameer-e-Millat University, Pakistan.; Department of Gastroenterology and Hepatology, Shifa International Hospital, Islamabad, Pakistan., Khan NY; Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan., Zia HH; Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan.; Shifa Tameer-e-Millat University, Pakistan., Atiq M; Shifa Tameer-e-Millat University, Pakistan.; Department of Gastroenterology and Hepatology, Shifa International Hospital, Islamabad, Pakistan.
Jazyk: angličtina
Zdroj: Journal of clinical and experimental hepatology [J Clin Exp Hepatol] 2024 Sep-Oct; Vol. 14 (5), pp. 101403. Date of Electronic Publication: 2024 Mar 26.
DOI: 10.1016/j.jceh.2024.101403
Abstrakt: Background and Objectives: Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality without liver transplantation (LT). The selection criteria for LT in these patients are not well defined. The objective of this study was to determine factors associated with post-transplant survival in ACLF.
Methods: This was a single-center retrospective study of patients who underwent living donor liver transplantation (LDLT) for ACLF between 2012 and 2022. Out of 1093 transplants, 110 patients had underlying ACLF, based on the European Association for the Study of the Liver-Chronic Liver Failure Consortium (EASL-CLIF) criteria. We looked at factors associated with 1-year posttransplant survival.
Results: The median model for end-stage liver disease (MELD) score was 33.5 (31-38), and the 1-year posttransplant survival was 72%. Six risk factors were associated with posttransplant survival, namely, body mass index > 30 kg/m 2 [HR, 4.4; 95% CI, 1.8-10.7], platelet count < 66,000/μl [HR, 2.91; CI,1.2-6.6], poor response to medical treatment [HR, 2.6; CI, 1.1-5.7], drug-resistant bacterial or fungal cultures [HR, 4.2; CI, 1.4-12.4], serum creatinine > 2.5 mg/dl [HR, 3.4; CI, 1.5-7.7], and graft-to-recipient weight ratio < 0.7 [HR, 4.8; CI, 1.4-16.3]. The 1-year post-transplant survival was 84% in patients with 0-2 risk factors (n = 89) and was 6% with 3 risk factors (n = 15) ( P < 0.001). For 1-year posttransplant survival, the area under curve (AUC) for the current model was 0.8 (0.69-0.9). The AUC for CLIF-ACLF, Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and EASL-CLIF ACLF grades was < 0.5.
Conclusion: In LT for ACLF, acceptable survival can be achieved when less than three high-risk factors are present.
(© 2024 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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