Abstract
Background and aims
Controversy exists over whether emergent liver transplantation (LT) should be performed
for patients with acute-on-chronic liver failure (ACLF), especially for patients with
multiple organ failure.
Methods
A total of 110 ACLF patients, defined by the European Association for the Study of
the Liver (EASL) Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA)
criteria were analyzed. The primary outcome was overall survival after ACLF diagnosis.
Results
During follow-up, 76 patients received LT (59 received deceased-donor LT and 17 patients
received living-donor LT). The overall survival was better for patients who received
LT than patients who did not (82.9% vs. 17.6%, P < 0.001). Among the 76 patients who received LT, the overall survival was not different
according to ACLF grade at diagnosis (70.0%, 85.3%, and 84.4% at one-year for ACLF
grades 1, 2, and 3, respectively, P = 0.45). The baseline model for end-stage liver disease (MELD) score and progression of
the ACLF grade during the pre-transplant period were independent factors for survival
after LT. The one-year survival rate was 92.3% for patients with baseline MELD scores
of ≤ 32 without ACLF grade progression, whereas it was 33.3% for those with baseline
MELD scores of > 32 and ACLF grade progression.
Conclusions
Emergent LT provided a significant survival benefit to ACLF patients, regardless of
the baseline ACLF grade. Post-LT outcomes were associated with baseline MELD scores
and ACLF progression during the pre-transplant period, which might be used in the
emergent LT plan for patients presenting with ACLF.
Keywords
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Article info
Publication history
Published online: April 27, 2021
Accepted:
March 25,
2021
Received in revised form:
March 24,
2021
Received:
October 8,
2020
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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- Reply to “Emergent liver transplantation for patients with acute-on-chronic liver failure”Digestive and Liver DiseaseVol. 53Issue 10
- PreviewWe would like to express our gratitude to Dr Li., for the interest and comments on our study [1]. Dr. Li pointed out the importance of medication (such as antibiotics and antiviral drugs) for the treatment of acute on chronic liver failure (ACLF) patients, and questioned the drug treatment strategy and percentage of antiviral resistance for patients with chronic hepatitis B virus (HBV) infection between groups. As pointed out by Dr Li, reactivation of HBV, either spontaneously or by emergence of drug-resistance, can be an important cause of ACLF, and appropriate antiviral therapy can improve patient survival [2,3].
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- Emergent liver transplantation for patients with acute-on-chronic liver failureDigestive and Liver DiseaseVol. 53Issue 10
- PreviewRecently, a cohort study based on the Korean population explored the predictors and prognostic parameters for patients with acute-on-chronic liver failure (ACLF) after emergent liver transplantation (LT) [1]. In this study, the authors adjusted for confounding factors using multivariable Cox regression analysis and found that ACLF patients benefited significantly from emergency LT compared with those without emergency LT. The conclusion of this study provides essential evidence for the treatment of ACLF patients, and is conducive to further improve the prognosis of ACLF patients.
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