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Liver Transpl. 2019 Feb 5. doi: 10.1002/lt.25426. [Epub ahead of print]

Outcomes after Listing for Liver Transplant in Patients with Acute-on-Chronic Liver Failure (ACLF): The Multicenter NACSELD Experience.

Author information

1
Dallas VA Medical Center, Dallas, TX, USA.
2
Baylor University Medical Center, Dallas, TX, USA.
3
Medicine Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.
4
University of Alberta, Edmonton, Alberta, Canada.
5
University of Washington, Seattle, WA, USA.
6
University of Toronto, Toronto, Ontario, Canada.
7
Mayo Clinic, Rochester, Minnesota, USA.
8
Yale University, New Haven, CT, USA.
9
University of Rochester, Rochester, New York, USA.
10
University of California, San Francisco, CA, USA.
11
University of Texas, Health Science Center, Houston, TX, USA.
12
Mayo Clinic, Scottsdale, AZ, USA.
13
Mercy Medical Center& University of Maryland School of Medicine, Baltimore, Maryland, USA.
14
Emory University, Atlanta, Georgia, USA.
15
Biostatistics, Richmond, Virginia, USA.
16
University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Abstract

Acute-on-Chronic Liver Failure (ACLF) characterized with ≥2 extra-hepatic organ failures in cirrhosis carries a high mortality. Outcomes of patients listed for liver transplant (LT) after ACLF and after LT are largely unknown. NACSELD (North American Consortium for the Study of End-Stage Liver Disease) prospectively enrolled 2,793 non-electively hospitalized patients with cirrhosis; 768 were LT-listed. Within 3-months 265 (34%) received a LT, 395 remained alive without LT, and 108 died/delisted. Compared to non-listed patients, those listed were younger, more often had ACLF, AKI, and a higher admission MELD. ACLF was most common in patients who died/de-listed, followed by those alive with and without LT respectively, (30%, 22% vs. 7%, p<0.001). At LT, median MELD was 28 and 70% were inpatients; median time from hospitalization to LT was 26 days. Post-LT survival at 6-months was unchanged between those with and without ACLF (93% each at 6-months). There was no difference in 3- and 6-month mean post-LT creatinine in those with and without ACLF, despite those with ACLF having a higher mean pre-LT creatinine and higher rate of perioperative dialysis (59%). CONCLUSION: Patients with and without ACLF had similar survival post-transplant with excellent renal recovery in both groups. This article is protected by copyright. All rights reserved.

PMID:
30724010
DOI:
10.1002/lt.25426

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