Survival outcomes after liver transplantation in acute-on-chronic liver failure: A prospective study.
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Gustot Thierry, Bernal William, Fernández Javier, Usón-Raposo Eva, Díaz Juan Manuel, Farias Alberto Queiroz, Rammohan Ashwin, Marciano Sebastián, Kuo Alexander, Perricone Giovanni, Bateman Rebecca, Bagulho Luis, Surendran Sudhindran, Colmenero Jordi, Mendizabal Manuel, Kemmer Nyingi, Gallegos-Orozco Juan F, Selzner Nazia, Elkrief Laure, Lindenmeyer Christina C, Jalal Prasun K, Anders Margarita, Lucidi Valerio, Vinaixa Aunés Carmen, Vizioli Luca, Zieniewicz Krzysztof, Della Penna Andrea, Mattos Angelo Z, Kriss Michael, Lampertico Pietro, Carone Linhares Livia Melo, Gambino Carmine, Castro-Narro Graciela Elia, Hoed Caroline den, Shetty Kirti, Pirani Tasneem, Giguet Baptiste, Michard Baptiste, Te Helen S, Yilmaz Sezai, Saraf Neeraj, Chauhan Abhishek, Hara Takanobu, Martin-Mateos Rosa, Lebossé Fanny, Toshima Takeo, Laleman Wim, Brol Maximilian Joseph, Campos-Varela Isabel, Weiss Emmanuel, Ohdan Hideki, Braun Felix, Karvellas Constantine J, Sinclair Marie, Engelmann Cornelius, Moore Joanna, Coilly Audrey, Loinaz Carmelo, Pageaux Georges-Philippe, Van Vlierberghe Hans, Liu Ken, Williams Michael John, Yong Chee Chien, Stein Lance L, Restrepo Juan-Carlos, Hasegawa Kiyoshi, Berlakovich Gabriela, Momoyo-Zitelli Patricia, Jothimani Dinesh, Nissen Nicholas N, D'Amico Federico, Cardoso Filipe S, Mohamed Zubair Umer, Ruiz Pablo, Pages Josefina, Dhanireddy Kiran, Salamé Ephrem, Eghtesad Bijan, Bhongade Megha, Brutti Julia, Putignano Antonella, Montalvá-Orón Eva, Di Donato Roberto, Raszeja-Wyszomirska Joanna, Zanotelli Maria Lúcia, Carneiro d'Albuquerque Luiz Augusto, Radhakrishnan Subathra, Martinez Jorge, Palomique Juvelyn, Marques Hugo P, Paul Anna, Pagano Giulia, Inge-Cox Richie Alexander, Carrilho Flair José, Martin Catherine Ann, Gomez Perdiguero Gonzalo, Andraus Wellington, Gadano Adrian, Rela Mohamed, Westbrook Rachel H, Berenguer Marina, Nadalin Silvio, Duvoux Christophe, Belli Luca Saverio, Sundaram Vinay, Tokat Yaman, Polak Wojciech G, Fondevila Constantino, Eguchi Susumu, McCaughan Geoffrey, Pomfret Elizabeth, Bosch-Comas Anna, Clària Joan, Angeli Paolo, Trebicka Jonel, Sánchez-Garrido Cristina, Samuel Didier, Moreau Richard, Arroyo Vicente, Jalan Rajiv, Investigators of the CHANCE study group
Аннотация
METHODS: Adults with decompensated cirrhosis with or without ACLF (grades 1-3), undergoing LT at 63 liver transplant centers worldwide were prospectively enrolled between 2021 and 2023 and followed for one year. Patients with ACLF-2 or ACLF-3 who were declined for LT were also prospectively followed for one year.
RESULTS: Among the 144 patients declined for LT, 73% of those included with ACLF-2 and 88% of those with ACLF-3 died within 1 year. Of the 612 transplanted patients, 2% were re-transplanted and 12% died during the year. According to ACLF status at LT, the case-fatality rate without re-transplantation was 21% with ACLF-3 (42% when patients had five or six organ failures), 10.5% with ACLF-2, 10% with ACLF-1 (one organ failure), and 9% without ACLF. During the post-LT period, ACLF-3 patients experienced longer intensive care stay but similar ward stay, readmission rate and requirement for long-term renal replacement therapy. In time-to-event multivariable analyses, variables that were associated with higher post-LT mortality were being transplanted in Asia (vs. Europe or North America) or having ACLF-3 at LT (vs. no ACLF). The risk of dying after LT was similar in Asia vs. Latin America or with ACLF-2 vs. no ACLF.
CONCLUSIONS: Patients with severe ACLF who underwent LT showed markedly better survival outcomes than those who were declined. Patients with five or six organ failures had high risk of post-LT death cautioning against routine LT in this population.
CLINICAL TRIAL NUMBER: ClinicalTrials.gov number, NCT04613921.