Outcomes of Liver Transplant Recipients with Acute-on-Chronic Liver Failure Based on EASL-CLIF Consortium Definition: A Single-center Study

Uchenna Agbim, Anuj Sharma, Benedict Maliakkal, Saradasri Karri, Masahiko Yazawa, William Goldkamp, Pradeep S.B. Podila, Jason M. Vanatta, Humberto Gonzalez, Miklos Z. Molnar, Satheesh P. Nair, James D. Eason, Sanjaya K. Satapathy

Research output: Contribution to journalArticle

Abstract

Background. The impact of acute-on-chronic liver failure (ACLF) defined by European Association for the Study of the Liver-Chronic Liver Failure in liver transplant (LT) recipients has not been well characterized. The aim of the study was to assess early posttransplant morbidity and survival of ACLF patients. Methods. Eight hundred twenty-five consecutive LT patients (04/2006-03/2013) were included in a retrospective analysis. Of the 690 evaluable patients, 589 had no ACLF, and the remaining 101 were grouped into ACLF Grades 1-3 (ACLF Grade 1: 50 [49.5%], ACLF Grade 2: 32 [31.7%], and ACLF Grade 3: 19 [18.8%]). Results. LT recipients transplanted in the context of ACLF had significantly increased serum creatinine (2.27 ± 1.16 versus 0.98 ± 0.32; P < 0.0001), and inferior 1-year graft (90% versus 78%; P < 0.0001) and patient survival (92% versus 82%; P = 0.0004) by Kaplan-Meier survival analysis; graft and patient survival correlated negatively with increasing severity of ACLF. One-year graft and patient survival were lower in those with high ACLF (Grade 2 and 3) irrespective of Model for End-Stage Liver Disease compared with other groups. The ACLF group had longer intensive care unit stays (10.6 ± 19.5 versus 4.2 ± 9; P < 0.0001), hospital stays (20.9 ± 25.9 versus 11.7 ± 11.4; P < 0.0001), and increased surgical re-exploration (26.7 % versus 14.6%, P = 0.002). Conclusions. Patients with ACLF undergoing LT have significantly higher resource utilization, inferior graft survival and patient survival, and renal dysfunction at 1 year. The combination of ACLF and Model for End-Stage Liver Disease can be considered when determining the suitability for potential transplantation.

Original languageEnglish
Article number00984
JournalTransplantation Direct
DOIs
Publication statusAccepted/In press - Jan 1 2020

ASJC Scopus subject areas

  • Transplantation

Fingerprint Dive into the research topics of 'Outcomes of Liver Transplant Recipients with Acute-on-Chronic Liver Failure Based on EASL-CLIF Consortium Definition: A Single-center Study'. Together they form a unique fingerprint.

  • Cite this

    Agbim, U., Sharma, A., Maliakkal, B., Karri, S., Yazawa, M., Goldkamp, W., Podila, P. S. B., Vanatta, J. M., Gonzalez, H., Molnar, M. Z., Nair, S. P., Eason, J. D., & Satapathy, S. K. (Accepted/In press). Outcomes of Liver Transplant Recipients with Acute-on-Chronic Liver Failure Based on EASL-CLIF Consortium Definition: A Single-center Study. Transplantation Direct, [00984]. https://doi.org/10.1097/TXD.0000000000000984