Acute on Chronic Liver Failure: Factors Associated With Transplantation. Issue 12 (December 2021)

• Record Type: Journal Article
• Authors: Goussous, Naeem; Xie, Wen; Zhang, Talan; Malik, Saad; Alvarez-Casas, Josue; Gray, Stephen H.; Barth, Rolf N.; Thuluvath, Paul J.; LaMattina, John C.
• Is Part Of: Transplantation direct. Volume 7:Issue 12(2021)
• Publication Date: 2021-12
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation -- Periodicals; 362.19795
• DOI: 10.1097/TXD.0000000000001245
• Languages: English
• ISSNs: 2373-8731

Abstract

Abstract : 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.