Patient Selection for Living Donor Liver Transplantation in Acute-on-chronic Liver Failure

Area of Science:

• Hepatology
• Transplantation Medicine
• Critical Care Medicine

Background:

• Acute-on-chronic liver failure (ACLF) presents a high short-term mortality risk without liver transplantation (LT).
• Current selection criteria for LT in ACLF patients are not well-defined, necessitating research into predictive factors for post-transplant outcomes.

Purpose of the Study:

• To identify factors associated with post-transplant survival in patients undergoing LT for ACLF.
• To evaluate the efficacy of LT in managing ACLF and determine optimal patient selection strategies.

Main Methods:

• A retrospective, single-center study analyzed 110 patients with ACLF who underwent living donor liver transplantation (LDLT) between 2012 and 2022.
• Factors influencing 1-year posttransplant survival were assessed using the European Association for the Study of the Liver-Chronic Liver Failure Consortium (EASL-CLIF) criteria.

Main Results:

• The 1-year posttransplant survival rate was 72%.
• Six risk factors significantly impacted survival: BMI > 30 kg/m², platelet count < 66,000/μl, poor medical treatment response, drug-resistant infections, serum creatinine > 2.5 mg/dl, and graft-to-recipient weight ratio < 0.7.
• Survival was 84% with 0-2 risk factors versus 6% with 3 risk factors (P < 0.001).

Conclusions:

• Liver transplantation for ACLF can achieve acceptable survival rates.
• Identifying and managing fewer than three high-risk factors is crucial for improving post-transplant outcomes in ACLF patients.