Effect of acute on chronic liver failure over post-transplant survival

Introduction and Objectives: Acute-on-chronic liver failure (ACLF) is associated with reduced short-term sur-vival, and liver transplantation is frequently the only therapeutic option. Nonetheless, the post-transplanta-tion prognosis seems to be worse in ACLF patients.Materials and Methods: The databases of two university centers were retrospectively evaluated, and adult patients with cirrhosis who underwent transplantation between 2013 and 2020 were included. One-year survival of patients with ACLF was compared to that of patients without ACLF. Variables associated with mor-tality were identified.Results: A total of 428 patients were evaluated, and 303 met the inclusion criteria; 57.1% were male, the mean age was 57.1 +/- 10.2 years, 75 patients had ACLF, and 228 did not. The main etiologies of ACLF were NASH (36.6%), alcoholic liver disease (13.9%), primary biliary cholangitis (8.6%) and autoimmune hepatitis (7.9%). Mechanical ventilation, renal replacement therapy, the use of vasopressors and the requirement of blood product transfusion during liver transplantation were significantly more frequent in ACLF patients. Among those recipients without and with ACLF, survival at 1, 3 and 5 years was 91.2% vs. 74.7%, 89.1% vs. 72.6% and 88.3% vs. 72.6%, respectively (p=0.001). Among pre-transplantation variables, only the presence of ACLF was independently associated with survival (HR 3.2, 95% CI: 1.46-7.11). Post-transplantation variables indepen-dently associated with survival were renal replacement therapy (HR 2.8, 95% CI: 1.1-6.8) and fungal infec-tions (HR 3.26, 95% CI: 1.07-9.9).Conclusions: ACLF is an independent predictor of one-year post-transplantation survival. Importantly, trans-plant recipients with ACLF require the use of more resources than patients without ACLF. (c) 2023 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)