Transplantation for EASL-CLIF and APASL acute-on-chronic liver failure (ACLF) patients: The TEA cohort to evaluate long-term post-Transplant outcomes

Lei Xia; Zi-Yun Qiao; Zi-Jie Zhang; Zi-Cheng Lv; Huan Tong; Ying Tong; Hao-Xiang Wu; Xiao-Song Chen; Han-Yong Sun; Jian-Jun Zhang; Wolfgang Ervin Thasler; Hao Feng; Qiang Xia

doi:10.1016/j.eclinm.2022.101476

Transplantation for EASL-CLIF and APASL acute-on-chronic liver failure (ACLF) patients: The TEA cohort to evaluate long-term post-Transplant outcomes

EClinicalMedicine. 2022 Jun 4:49:101476. doi: 10.1016/j.eclinm.2022.101476. eCollection 2022 Jul.

Authors

Lei Xia¹, Zi-Yun Qiao¹, Zi-Jie Zhang¹, Zi-Cheng Lv¹, Huan Tong², Ying Tong¹, Hao-Xiang Wu¹, Xiao-Song Chen^{1

3}, Han-Yong Sun^{1

3}, Jian-Jun Zhang¹, Wolfgang Ervin Thasler⁴, Hao Feng^{1

3

5}, Qiang Xia^{1

3

5}

Affiliations

¹ Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
² Shanghai First Maternity and Infant Hospital, Shanghai 200127, China.
³ Shanghai Engineering Research Centre of Transplantation and Immunology, Shanghai 200127, China.
⁴ Department of General, Visceral, Thoracic and Minimally Invasive Surgery, Rotkreuzklinikum Munich, Nymphenburger Str. 163 80634, Munich, Germany.
⁵ Shanghai Institute of Transplantation, Shanghai 200127, China.

Abstract

Background: The forecast accuracy of the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) and Asian Pacific Association for the Study of the Liver (APASL) acute-on-chronic liver failure (ACLF) criteria in assessing long-term outcomes after liver transplantation (LT) is still unclear, especially when the staging of the two standards is inconsistent.

Methods: A retrospective cohort (NCT05036031) including 565 patients from January 2015 to June 2021 was conducted. The 28 and 90 days, 1- and 3-years overall survival (OS) after LT were compared between different grades.

Findings: Total of 162 (28.7%) and 230 (40.7%) patients met the ACLF standards. In the EASL-CLIF criteria, the 3-year OS rates were 83·0%, 80·3%, and 69·8% for ACLF1-3, respectively. In the APASL criteria, the 3-year OS rates were 85·7% for APASL ACLF Research Consortium (AARC)-1, similar to ACLF-1. The 3-year OS rates were 84·5% for AARC-2, which were slightly better than ACLF-2. Regarding AARC-3, the 3-year OS rate was 5·8% higher than ACLF-3. For patients who met neither set of criteria for ACLF, the 3-year OS rates were 89·8%. The multivariate analysis showed that alanine aminotransferase >100 U/L, respiration failure, and cerebral failure were independent risk factors for post-LT death.

Interpretation: This study provides the first large-scale long-term follow-up data in Asia. Both criteria showed favorable distinguishing ability for post-LT survival. Patients with ACLF had a higher post-LT mortality risk, and ACLF-3 and AARC-3 correlated with significantly greater mortality.

Funding: National Natural Science Foundation of China and Science and Technology Commission of Shanghai Municipality.

Keywords: AARC, APASL ACLF Research Consortium; ACLF, acute-on-chronic liver failure; AD, acute decompensation; AIH, autoimmune hepatitis; ALT, alanine aminotransferase; APASL, Asian Pacific Association for the Study of the Liver; AST, aspartate aminotransferase; Acute-on-chronic liver failure; CLIF-C OFs, CLIF-C organ failure score; CsA, cyclosporine; Decompensation; EASL-CLIF, European Association for the Study of the Liver-Chronic Liver Failure; ECLIS, ELITA/EF-CLIF collaborative study; HBV, Hepatitis B virus; HE, hepatic encephalopathy; ICU, Intensive care unit; INR, international normalized ratio; IQR, interquartile range; LDLT, living donor liver transplantation; LT, liver transplantation; Liver; Liver transplantation; MDRO, multidrug-resistant organism; MELD, Model for End-Stage Liver Disease score; MMF, mycophenolate mofetil; OLT, orthotopic liver transplantation; OS, overall survival; Overall survival; SBP, spontaneous bacterial peritonitis; SLT, split liver transplantation; TB, total bilirubin; TEA, Transplantation for EASL-CLIF and APASL acute-on-chronic liver failure (ACLF) patients; WBC, white blood count.