Outcome of Liver Transplantation for Critically Ill Acute on Chronic Liver Failure Recipients Complicated With Pretransplant Invasive Pulmonary Aspergillosis
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View abstract on PubMed
Summary
This summary is machine-generated.Liver transplantation for patients with acute-on-chronic liver failure and invasive pulmonary Aspergillosis shows suboptimal survival rates, even with antifungal treatment. Case-by-case multidisciplinary evaluation is crucial before proceeding with liver transplantation.
Area Of Science
- Hepatology
- Transplantation Medicine
- Infectious Diseases
Background
- Patients with acute-on-chronic liver failure (ACLF) are at high risk for fungal infections.
- Pretransplant invasive pulmonary Aspergillosis (IPA) is typically a contraindication for liver transplantation (LT).
Purpose Of The Study
- To evaluate posttransplant outcomes in ACLF patients with pretransplant IPA compared to those without.
- To determine the impact of pretransplant IPA on survival after LT in ACLF patients.
Main Methods
- A multi-center retrospective study of adult ACLF patients who underwent LT with pretransplant IPA.
- Comparison with a matched control group of ACLF patients without preoperative Aspergillus infection.
- Evaluation of posttransplant outcomes and mortality rates between the groups.
Main Results
- 21 ACLF patients with pretransplant IPA were identified, with a mean MELD score of 28.6.
- Most patients received antifungal therapy, primarily voriconazole, for a median of 9 days pre-LT.
- Higher 3-month (38.1%) and 12-month (42.9%) mortality rates were observed in the IPA group compared to controls (p < 0.05).
Conclusions
- Survival following LT for ACLF patients with pretransplant IPA is suboptimal, despite peri-transplant antifungal treatment.
- Pretransplant IPA significantly increases mortality risk in ACLF patients undergoing LT.
- Individualized, multidisciplinary assessment is essential for decision-making regarding LT in ACLF patients with IPA.
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