Acute on Chronic Liver Failure: Factors Associated With Transplantation

Naeem Goussous; Wen Xie; Talan Zhang; Saad Malik; Josue Alvarez-Casas; Stephen H Gray; Rolf N Barth; Paul J Thuluvath; John C LaMattina

doi:10.1097/TXD.0000000000001245

Acute on Chronic Liver Failure: Factors Associated With Transplantation

Transplant Direct. 2021 Nov 17;7(12):e788. doi: 10.1097/TXD.0000000000001245. eCollection 2021 Dec.

Authors

Naeem Goussous¹, Wen Xie¹, Talan Zhang², Saad Malik¹, Josue Alvarez-Casas¹, Stephen H Gray¹, Rolf N Barth², Paul J Thuluvath², John C LaMattina¹

Affiliations

¹ Division of transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
² Department of Medicine, Mercy Medical Center, University of Maryland School of Medicine, Baltimore, MD.

Abstract

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.