Background and Aims
Patients with acute-on-chronic liver failure (ACLF) show excess mortality in MELD-Na based organ allocation for liver transplantation (LT). Whether MELD-based allocation in the Eurotransplant region similarly underprioritizes ACLF patients is unknown.
428 patients listed for LT from 01/2010 to 02/2021 at a tertiary center in Germany were screened and 209 patients included as derivation (n = 123) and validation cohort (n = 86). Competing risk analysis for waitlist mortality and LT as competing events was performed.
90-day waitlist mortality for patients with MELD < and ≥ 25 at baseline was 9% vs. 33%, respectively (p = 0.009). Competing risk analysis shows significantly higher 90-day waitlist mortality in patients listed with ACLF compared to those without ACLF (p = 0.021) in the low MELD stratum. Probability of LT was similar between the two groups (p = 0.91). In the high MELD group, 90-day waitlist mortality and rates of LT were not significantly different between patients with and without ACLF (31% vs. 20%, p = 0.55 and 59% vs. 60%, p = 0.72, respectively). Post-transplant survival was similar between patients with and without ACLF. This result was confirmed in the validation cohort.
MELD-based organ allocation in the Eurotransplant region underestimates waitlist mortality in patients with ACLF in lower MELD ranges.
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- Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis.Gastroenterology. 2013; 144 (e9): 1426-1437
- Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis.Hepatol Baltim Md. 2015; 62: 243-252
- Systemic inflammation in decompensated cirrhosis: characterization and role in acute-on-chronic liver failure.Hepatol Baltim Md. 2016; 64: 1249-1264
- Addressing Profiles of Systemic Inflammation Across the Different Clinical Phenotypes of Acutely Decompensated Cirrhosis.Front Immunol. 2019; 10: 476
- Cardiodynamic state is associated with systemic inflammation and fatal acute-on-chronic liver failure.Liver Int Off J Int Assoc Study Liver. 2020;
- Differential inflammasome activation predisposes to acute-on-chronic liver failure in human and experimental cirrhosis with and without previous decompensation.Gut. 2020; (gutjnl-2019-320170)
- Hepatic inflammasome activation as origin of Interleukin-1α and Interleukin-1β in liver cirrhosis.Gut. 2020;
- Factors associated with survival of patients with severe acute-on-chronic liver failure before and after liver transplantation.Gastroenterology. 2019; 156 (e3): 1381-1391
- Liver transplantation in patients with multiple organ failures: feasibility and outcomes.J Hepatol. 2018; 69: 1047-1056
- Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: results of the ELITA/EF-CLIF collaborative study (ECLIS).J Hepatol. 2021; S0168827821002610
- Model for end-stage liver disease-sodium underestimates 90-day mortality risk in patients with acute-on-chronic liver failure.J Hepatol. 2020; 73: 1425-1433
- EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis.J Hepatol. 2018; 69: 406-460
- The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology.J Hepatol. 2020; 73: 842-854
- PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis.J Hepatol. 2020; S0168827820337727
- Grade 1 Acute on Chronic Liver Failure Is a Predictor for Subsequent Grade 3 Failure.Hepatology. 2020; 72: 230-239
- Impact of acute-on-chronic liver failure on 90-day mortality following a first liver transplantation.Liver Int Off J Int Assoc Study Liver. 2017; 37: 684-693
- Liver transplantation in the most severely ill cirrhotic patients: a multicenter study in acute-on-chronic liver failure grade 3.J Hepatol. 2017; 67: 708-715
- Acute-on-chronic liver failure: excellent outcomes after liver transplantation but high mortality on the wait list.Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2013; 19: 879-886
- Sarcopenia is associated with development of acute-on-chronic liver failure in decompensated liver cirrhosis receiving transjugular intrahepatic portosystemic shunt.Clin Transl Gastroenterol. 2019; 10: e00025
- Fat-free muscle mass in magnetic resonance imaging predicts acute-on-chronic liver failure and survival in decompensated cirrhosis.Hepatology. 2018; 67: 1014-1026
Published online: January 04, 2022
Accepted: December 16, 2021
Received: May 21, 2021
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.