Acute on Chronic Liver Failure: Factors Associated With Transplantation

Naeem Goussous, MD; Wen Xie, MD; Talan Zhang, MS; Saad Malik, MD; Josue Alvarez-Casas, MD; Stephen H. Gray, MD; Rolf N. Barth, MD; Paul J. Thuluvath, MD; John C. LaMattina, MD

doi:10.1097/TXD.0000000000001245

Transplantation Direct (Dec 2021)

Acute on Chronic Liver Failure: Factors Associated With Transplantation

Naeem Goussous, MD,
Wen Xie, MD,
Talan Zhang, MS,
Saad Malik, MD,
Josue Alvarez-Casas, MD,
Stephen H. Gray, MD,
Rolf N. Barth, MD,
Paul J. Thuluvath, MD,
John C. LaMattina, MD

Affiliations

Naeem Goussous, MD: 1 Division of transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Wen Xie, MD: 1 Division of transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Talan Zhang, MS: 2 Department of Medicine, Mercy Medical Center, University of Maryland School of Medicine, Baltimore, MD.
Saad Malik, MD: 1 Division of transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Josue Alvarez-Casas, MD: 1 Division of transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Stephen H. Gray, MD: 1 Division of transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Rolf N. Barth, MD: 2 Department of Medicine, Mercy Medical Center, University of Maryland School of Medicine, Baltimore, MD.
Paul J. Thuluvath, MD: 2 Department of Medicine, Mercy Medical Center, University of Maryland School of Medicine, Baltimore, MD.
John C. LaMattina, MD: 1 Division of transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.

DOI: https://doi.org/10.1097/TXD.0000000000001245
Journal volume & issue: Vol. 7, no. 12
p. e788

Abstract

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Background. Acute on chronic liver failure (ACLF) carries a poor prognosis unless liver transplantation is offered. We present risk factors associated with proceeding with liver transplantation in patients with ACLF. Methods. A retrospective review of all patients with ACLF who presented to a single transplant center between January 2016 and December 2017 was performed. We compared patients who were transplanted with patients who were not. Results. During the study period, 144 patients with ACLF were identified, 86 patients (59.7%) were transplanted, and 58 were not. The transplanted patients had a lower number of failed organs (4 versus 5, P < 0.001) and lower incidence of ACLF grade 3 (76.7% versus 94.8%, P = 0.014) compared with nontransplanted patients. Liver transplantation offered a 1-y survival of 86% as compared to 12% in the nontransplanted group. Hospital charges were significantly higher among transplanted patients as compared with the nontransplanted patients ($227 886 versus $88 900, P < 0.001). Elevated serum lactate was a risk factor in not offering liver transplantation in ACLF patients. Conclusions. In appropriately selected patients with ACLF, liver transplantation is feasible and can provide above 86% 1-y patient survival even in grade 3 ACLF.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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