Liver Transplantation in Acute-on-Chronic Liver Failure: Excellent Outcome and Difficult Posttransplant Course

Area of Science:

• Hepatology
• Transplantation Medicine
• Critical Care Medicine

Background:

• Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality.
• Comparing outcomes for ACLF patients undergoing liver transplantation versus conservative management is crucial.
• Understanding the comparative prognosis of ACLF recipients against decompensated cirrhosis recipients is essential.

Purpose of the Study:

• To compare the prognosis of transplanted ACLF patients with nontransplanted ACLF patients.
• To evaluate the outcomes of ACLF recipients against those of decompensated cirrhosis recipients post-transplantation.
• To assess the impact of liver transplantation on survival rates in ACLF patients, particularly severe cases.

Main Methods:

• Retrospective collection of clinical data from 29 transplanted ACLF patients, 312 nontransplanted ACLF patients, and 60 transplanted decompensated cirrhosis patients.
• Application of Propensity Score Matching (PSM) analysis to ensure comparability between patient groups.
• Analysis of 90-day and 1-year survival rates, mechanical ventilation duration, ICU and hospital stay, tracheotomy incidence, healthcare expenses, and complication morbidity.

Main Results:

• Transplanted ACLF patients demonstrated significantly improved 90-day and 1-year survival compared to nontransplanted controls.
• ACLF recipients showed similar 90-day and 1-year survival to decompensated cirrhosis recipients, but with increased healthcare utilization (longer ventilation, ICU/hospital stays, higher costs, more tracheotomies, and complications).
• Liver transplantation significantly improved survival for severe ACLF (grade 2-3) patients compared to non-transplanted counterparts.

Conclusions:

• Liver transplantation is a highly effective intervention for improving the prognosis of ACLF patients.
• Despite increased resource utilization and complications, ACLF recipients achieve comparable short- and long-term survival to decompensated cirrhosis recipients.
• Liver transplantation offers substantial survival benefits for patients with severe ACLF, underscoring its role in managing this critical condition.