The Lancet Regional Health. Western Pacific (Mar 2023)

Predicting the survival benefit of liver transplantation in HBV-related acute-on-chronic liver failure: an observational cohort studyResearch in context

  • Peng Li,
  • Xi Liang,
  • Jinjin Luo,
  • Jiaqi Li,
  • Jiaojiao Xin,
  • Jing Jiang,
  • Dongyan Shi,
  • Yingyan Lu,
  • Hozeifa Mohamed Hassan,
  • Qian Zhou,
  • Shaorui Hao,
  • Huafen Zhang,
  • Tianzhou Wu,
  • Tan Li,
  • Heng Yao,
  • Keke Ren,
  • Beibei Guo,
  • Xingping Zhou,
  • Jiaxian Chen,
  • Lulu He,
  • Hui Yang,
  • Wen Hu,
  • Shiwen Ma,
  • Bingqi Li,
  • Shaoli You,
  • Shaojie Xin,
  • Yu Chen,
  • Jun Li

Journal volume & issue
Vol. 32
p. 100638

Abstract

Read online

Summary: Background: Liver transplantation (LT) is an effective therapy for acute-on-chronic liver failure (ACLF) but is limited by organ shortages. We aimed to identify an appropriate score for predicting the survival benefit of LT in HBV-related ACLF patients. Methods: Hospitalized patients with acute deterioration of HBV-related chronic liver disease (n = 4577) from the Chinese Group on the Study of Severe Hepatitis B (COSSH) open cohort were enrolled to evaluate the performance of five commonly used scores for predicting the prognosis and transplant survival benefit. The survival benefit rate was calculated to reflect the extended rate of the expected lifetime with vs. without LT. Findings: In total, 368 HBV-ACLF patients received LT. They showed significantly higher 1-year survival than those on the waitlist in both the entire HBV-ACLF cohort (77.2%/52.3%, p 10. These results were prospectively validated. Interpretation: COSSH-ACLF IIs identified the risk of death on the waitlist and accurately predicted post-LT mortality and survival benefit for HBV-ACLF. Patients with COSSH-ACLF IIs 7–10 derived a higher net survival benefit from LT. Funding: This study was supported by the National Natural Science Foundation of China (No. 81830073, No. 81771196) and the National Special Support Program for High-Level Personnel Recruitment (Ten-thousand Talents Program).

Keywords