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Updated: May 1, 2026
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Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure
Published on: September 13, 2014
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Failure to rescue in acute liver failure: A multicenter cohort study
Filipe S Cardoso1, William M Lee2, Constantine J Karvellas3
1Departments of Hepatology and Critical Care, Curry Cabral Hospital, Nova Medical School, Lisbon, Portugal.
Summary
Failure to rescue, a measure of care quality for surgical complications, is poorly understood in acute liver failure (ALF). This study found that early medical complications in ALF patients significantly increase transplant-free mortality, emphasizing improved management needs.
Area of Science:
- Hepatology
- Critical Care Medicine
- Health Services Research
Background:
- Failure to rescue (FTR) is a quality metric for surgical complications but is understudied in primary medical conditions like acute liver failure (ALF).
- Assessing FTR in ALF patients is crucial for understanding and improving outcomes in this vulnerable population.
Purpose of the Study:
- To investigate the concept of failure to rescue in patients with acute liver failure (ALF).
- To determine the association between early medical complications and 21-day transplant-free mortality in ALF patients.
Main Methods:
- Retrospective multicenter cohort study using the United States ALF Study Group (USALFSG) registry (2010-2016).
- Calculated FTR rate for 12 medical complications and analyzed their association with 21-day transplant-free mortality.
- Adjusted for age, sex, etiology, and international normalized ratio.
Main Results:
- Among 665 ALF patients, 69.3% had at least one medical complication on day 1.
- The overall FTR rate for 12 complications was 32.8%.
- Each additional complication on day 1 increased the odds of 21-day transplant-free mortality by 38% (aOR 1.38).
Conclusions:
- The concept of failure to rescue is relevant in acute liver failure (ALF) and highlights significant risks associated with early medical complications.
- Improving the prevention, early detection, and timely management of medical complications in ALF patients is essential to reduce mortality.
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