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Published on: November 7, 2020
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Acute on Chronic Liver Failure: Factors Associated With Transplantation
Naeem Goussous1, Wen Xie1, Talan Zhang2
1Division of transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Transplantation Direct
|November 22, 2021
Summary
Liver transplantation significantly improves survival for patients with acute on chronic liver failure (ACLF). Careful patient selection is key, as elevated lactate levels may indicate a need for non-transplant management.
Area of Science:
- Hepatology
- Transplant Surgery
- Critical Care Medicine
Background:
- Acute on chronic liver failure (ACLF) presents a critical clinical challenge with a generally poor prognosis.
- Liver transplantation is a potential life-saving intervention for select ACLF patients.
- Identifying factors influencing transplantation decisions in ACLF is crucial for improving outcomes.
Purpose of the Study:
- To identify risk factors associated with liver transplantation in patients diagnosed with ACLF.
- To compare outcomes and characteristics of ACLF patients who underwent transplantation versus those who did not.
- To evaluate the feasibility and survival benefit of liver transplantation in ACLF.
Main Methods:
- A retrospective review was conducted on 144 ACLF patients presenting to a single transplant center from January 2016 to December 2017.
- Patients were categorized into transplanted (n=86) and non-transplanted (n=58) groups for comparative analysis.
- Key metrics analyzed included organ failure count, ACLF grade, survival rates, hospital charges, and serum lactate levels.
Main Results:
- Transplanted patients exhibited fewer organ failures (4 vs. 5) and a lower incidence of ACLF grade 3 (76.7% vs. 94.8%) compared to non-transplanted patients.
- Liver transplantation resulted in a 1-year survival rate of 86%, significantly higher than the 12% observed in the non-transplanted group.
- Elevated serum lactate was identified as a risk factor for not proceeding with liver transplantation in ACLF patients, despite higher hospital charges for transplanted individuals.
Conclusions:
- Liver transplantation is a viable and effective treatment option for carefully selected ACLF patients, including those with grade 3 ACLF.
- A 1-year survival rate exceeding 86% is achievable with transplantation in this high-risk population.
- Risk stratification, potentially including serum lactate levels, is essential for optimizing liver transplantation candidacy in ACLF.
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