Related Experiment Video
Updated: May 5, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Living Donor Liver Transplantation in Patients with or Without Acute-on-Chronic Liver Failure: A Single Center
Bandar Aljudaibi1, Lama Alshehri1, Bedour Almudaiheem1
1Organ Transplant Centre of Excellence, King Faisal Specialists and Research Centre, Riyadh 11211, Saudi Arabia.
Insights
Living donor liver transplantation (LDLT) for acute-on-chronic liver failure (ACLF) patients presents higher perioperative risks and reduced survival compared to non-ACLF recipients. Chronic kidney disease independently predicts mortality in these patients.
Area of Science:
- Hepatology and Transplant Surgery
- Critical Care Medicine
- Nephrology
Background:
- Acute-on-chronic liver failure (ACLF) is a critical condition in chronic liver disease (CLD) patients, marked by multi-organ failure and high mortality.
- Living donor liver transplantation (LDLT) is a crucial intervention for ACLF patients, especially in regions with limited organ availability.
Purpose of the Study:
- To compare baseline characteristics, perioperative complications, and long-term survival between ACLF and non-ACLF patients undergoing LDLT.
- To evaluate the impact of ACLF etiology, severity grading, and graft factors on patient and graft survival.
Main Methods:
- Analysis of a prospective registry data of 591 adult LDLT recipients between 2019 and 2023.
- ACLF diagnosis based on EASL-CLIF and APASL criteria, assessed pre-transplant.
- Comparison of clinical parameters, complication rates, and survival outcomes between ACLF and non-ACLF groups.
Main Results:
- ACLF patients (17.1%) exhibited higher MELD-Na, bilirubin, creatinine, and prevalence of metabolic/genetic etiologies and chronic kidney disease, with lower HCC rates.
- The ACLF group experienced significantly higher rates of infection, bleeding, and biliary complications, alongside longer ICU and hospital stays.
- Five-year overall and graft survival rates were significantly reduced in ACLF patients, with outcomes worsening according to ACLF grade (EASL-CLIF).
Conclusions:
- LDLT for ACLF patients is associated with increased perioperative risks and poorer long-term outcomes compared to non-ACLF recipients.
- ACLF severity grading directly correlates with decreased patient survival.
- Chronic kidney disease is identified as an independent predictor of mortality in LDLT recipients.
Abstract:
Background/Objectives: Acute-on-chronic liver failure (ACLF) is a severe syndrome in chronic liver disease (CLD) patients, characterized by multi-organ failure and high mortality. Living donor liver transplantation (LDLT) is vital in donor-scarce areas. This study compares baseline characteristics, perioperative complications, and long-term survival between ACLF and non-ACLF patients, emphasizing etiology, ACLF grading, and graft factors. Methods: Data from a prospective registry of 591 adult LDLT recipients (2019-2023) were analyzed. ACLF was defined by EASL-CLIF (multi-organ failure, grades 1-3) and APASL (jaundice/coagulopathy with complications) criteria, evaluated at initial assessment and within 24 h pre-LDLT. Results: ACLF patients (n = 101, 17.1%) showed higher MELD-Na (27 vs. 20, p < 0.001), bilirubin (6.84 vs. 1.75 mg/dL, p < 0.001), creatinine (108 vs. 70.5 μmol/L, p < 0.001), metabolic/genetic etiologies (9.9% vs. 2.8%, p = 0.001), and chronic kidney disease (23.7% vs. 8.1%, p < 0.001), and lower HCC rates (11.8% vs. 29.6%, p < 0.001). GRWR was marginally lower in ACLF patients (0.59 vs. 0.66, p = 0.10). The ACLF group had elevated infection (27.7% vs. 10.4%, p < 0.001), bleeding (14.9% vs. 6.3%, p = 0.004), and biliary complications (15.8% vs. 7.8%, p = 0.010), with longer ICU (5 vs. 3 days, p < 0.001) and hospital stays (33.66 vs. 20.7 days, p = 0.036). Five-year overall survival was reduced in ACLF patients (log-rank p = 0.001), worsening with grade (EASL-CLIF grade 3: 55% vs. 81% for no ACLF, p = 0.002). Graft survival was also lower (75% vs. 85%, p = 0.02). Multivariable analysis identified chronic kidney disease as an independent mortality predictor (HR 2.09, 95% CI 1.11-3.95, p = 0.023). Conclusions: LDLT for ACLF involves higher perioperative risks and poorer long-term survival than non-ACLF patients, with outcomes deteriorating by ACLF grade. Chronic kidney disease independently predicts mortality. Timely LDLT is essential in donor-limited regions.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure