P- 57 SURVIVAL AND LIVER TRANSPLANTATION FOR PATIENTS WITH ACUTE ON CHRONIC LIVER FAILURE IN URUGUAY

Abstract

Introduction and Objectives: Acute on chronic liver failure (AoCLF) is a syndrome characterized by acute decompensation of a patient with cirrhosis, with multi-organ failure and high short-term mortality. Liver transplantation (LT) is the treatment of choice. Characterizing these patients is important to optimize the best management strategy. This study aimed to assess the survival of patients with AoCLF evaluated for LT in Uruguay and to identify variables associated with mortality. Materials and Methods: Retrospective analysis of adult patients evaluated for LT with AoCLF in the National Liver Transplant Program of Uruguay (January 2018 - December 2021). Results: 97 patients were evaluated, and 25 (26%) had AoCLF. The median age was 51 ± 12 years. 64% were male. The most frequent etiology of cirrhosis was alcoholic (n:11, 44%). The MELD-Na score at diagnosis was 29.4 ± 6.3. Twenty-one patients were Child-Pugh C. The grades of AoCLF were 1 in 9, 2 in 11, and 3 in 5 patients. In 64% of patients, a precipitating cause was identified: intercurrent infection in 13, upper gastrointestinal bleeding in 5, and acute alcoholic hepatitis in 2. The CLIF-C ACLF score at diagnosis was 48.1 ± 9.8. 13 patients progressively increased the number of failures, and 9 of them had an intercurrent infection. Twelve patients were listed, and 6 of them were transplanted. Overall mortality was 72%, on the waiting list 54% and post-LT 33%. Survival was different among patients with LT vs. non-LT (p<0.001) (Figure 1), according to the degree of AoCLF (p = 0.001) and if an intercurrent infection was present (p = 0.022). Conclusions: AoCLF is a frequent indication of LT in Uruguay, with high mortality associated with the degree of ACLF, the presence of infection and non-transplantation. It is important to achieve transplantability of these patients, given the improvement in survival with LT.