Outcomes of Liver Transplantation Among Patients Diagnosed With Acute-on-Chronic Liver Failure: A Single-Center Experience.

BACKGROUND

Acute-on-chronic liver failure (ACLF) describes the rapid deterioration of liver function triggered by factors including alcohol consumption, infection(s), and exacerbation(s) of chronic liver disease, and is characterized by a persistent "cytokine storm." While liver transplantation is the most effective treatment, comprehensive data regarding patient outcomes are limited.

METHODS

Clinical data from 187 patients, who underwent liver transplantation (excluding re-transplantations and acute liver failure) between 2009 and 2023, were analyzed in accordance with Japan's ACLF diagnostic criteria. Immunological analysis included a mixed lymphocyte reaction with carboxyfluorescein succinimidyl ester staining (CFSE-MLR).

RESULTS

Among 171 patients, 13 had ACLF (grade 0, n = 6; grade 2, n = 5; grade 3, n = 2), and 158 had non-ACLF. Five-year survival rates for the ACLF and non-ACLF groups were similar regardless of ACLF severity. Patients with ACLF had higher preoperative Model for End-stage Liver Disease (ie, "MELD") scores and Child-Pugh scores, and higher rates of dialysis, renal dysfunction, and respiratory failure (P < .05). The graft rejection rate was higher in the ACLF group than that in the non-ACLF group, and the CFSE-MLR assay revealed significantly elevated CD8-positive T cell responses to donor antigens in the first week post-transplantation.

CONCLUSION

Patients with ACLF achieved favorable postoperative outcomes despite poor preoperative conditions. High mortality rates among patients with ACLF on transplant waitlists emphasize the importance of timely transplantation. The increased anti-donor immune response after transplantation suggests a role for the underlying cytokine storm and underscores the need for careful postoperative management.