Acute-on-chronic liver failure: Excellent outcomes after liver transplantation but high mortality on the wait list

被引:142
作者
Finkenstedt, Armin [1 ]
Nachbaur, Karin [1 ]
Zoller, Heinz [1 ]
Joannidis, Michael [2 ]
Pratschke, Johann [3 ]
Graziadei, Ivo W. [1 ]
Vogel, Wolfgang [1 ]
机构
[1] Med Univ Innsbruck, Dept Internal Med 2, A-6020 Innsbruck, Austria
[2] Med Univ Innsbruck, Dept Internal Med 1, Intens Care Unit, A-6020 Innsbruck, Austria
[3] Med Univ Innsbruck, Dept Transplantat Surg, A-6020 Innsbruck, Austria
关键词
HEPATITIS-B; INTENSIVE-CARE; GUIDELINES; SEPSIS; CIRRHOSIS; DIALYSIS; SIRS;
D O I
10.1002/lt.23678
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Acute-on-chronic liver failure (ACLF) is characterized by high short-term mortality. Liver transplantation (LT) is a potential therapy for patients who do not improve with supportive measures, but the efficacy of LT has not been shown. The aim of this study was to investigate the feasibility of LT and to determine the postoperative outcomes of patients with ACLF. All patients referred to our liver unit between 2002 and 2010 were registered in a database. The diagnosis of ACLF was made in accordance with the Asian Pacific Association for the Study of the Liver consensus. The post-LT outcomes were compared with the outcomes of a cohort of patients with chronic liver disease who underwent transplantation for other indications during the same period. One hundred forty four of 238 patients fulfilled the ACLF criteria. In an intention-to-treat analysis, the median transplant-free survival time was 48 days. Multiorgan failure was the most common cause of death. Ninety-four patients (65%) were evaluated for LT, 71 patients (49%) were listed, and 33 patients (23%) finally underwent deceased donor LT; this resulted in a wait-list mortality rate of 54%. Patients who developed infectious complications (particularly pneumonia and/or sepsis) and patients who received renal replacement therapy or mechanical ventilation were less likely to undergo LT. The 1- and 5-year survival rates of 87% and 82% were comparable to the rates for non-ACLF patients. In conclusion, this study shows that LT remains the only therapeutic option for the vast majority of patients with ACLF. However, LT was feasible in less than one fourth of the patients with a 5-year survival rate greater than 80%. Liver Transpl 19:879-886, 2013. (c) 2013 AASLD.
引用
收藏
页码:879 / 886
页数:8
相关论文
共 25 条
[1]   Acute-on-Chronic Liver Failure Before Liver Transplantation: Impact on Posttransplant Outcomes [J].
Bahirwani, Ranjeeta ;
Shaked, Oren ;
Bewtra, Meenakshi ;
Forde, Kimberly ;
Reddy, K. Rajender .
TRANSPLANTATION, 2011, 92 (08) :952-957
[2]   DEFINITIONS FOR SEPSIS AND ORGAN FAILURE AND GUIDELINES FOR THE USE OF INNOVATIVE THERAPIES IN SEPSIS [J].
BONE, RC ;
BALK, RA ;
CERRA, FB ;
DELLINGER, RP ;
FEIN, AM ;
KNAUS, WA ;
SCHEIN, RMH ;
SIBBALD, WJ .
CHEST, 1992, 101 (06) :1644-1655
[3]   Sir Isaac Newton, sepsis, SIRS, and CARS [J].
Bone, RC .
CRITICAL CARE MEDICINE, 1996, 24 (07) :1125-1128
[4]   Liver transplantation for acute-on-chronic liver failure [J].
Chan, Albert C. ;
Fan, Sheung Tat ;
Lo, Chung Mau ;
Liu, Chi Leung ;
Chan, See Ching ;
Ng, Kelvin K. ;
Yong, Boon Hun ;
Chiu, Alexander ;
Lam, Banny K. .
HEPATOLOGY INTERNATIONAL, 2009, 3 (04) :571-581
[5]  
Chen ZY, 2011, HEPATO-GASTROENTEROL, V58, P1267, DOI 10.5754/hge10148
[6]   Non-hepatic Insults Are Common Acute Precipitants in Patients with Acute on Chronic Liver Failure (ACLF) [J].
Duseja, Ajay ;
Chawla, Y. K. ;
Dhiman, R. K. ;
Kumar, Amit ;
Choudhary, Narendra ;
Taneja, Sunil .
DIGESTIVE DISEASES AND SCIENCES, 2010, 55 (11) :3188-3192
[7]   Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure [J].
Garg, Hitendra ;
Kumar, Ashish ;
Garg, Vishal ;
Sharma, Praveen ;
Sharma, Barjesh Chander ;
Sarin, Shiv Kumar .
DIGESTIVE AND LIVER DISEASE, 2012, 44 (02) :166-171
[8]   EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis European Association for the Study of the Liver [J].
Gines, Pere ;
Angeli, Paolo ;
Lenz, Kurt ;
Moller, Soren ;
Moore, Kevin ;
Moreau, Richard ;
Merkel, Carlo ;
Ring-Larsen, Helmer ;
Bernardi, Mauro .
JOURNAL OF HEPATOLOGY, 2010, 53 (03) :397-417
[9]   Rituximab-induced hepatitis C virus reactivation after spontaneous remission in diffuse large B-cell lymphoma [J].
Hsieh, Ching-Yun ;
Huang, Hsin-Hui ;
Lin, Chen-Yuan ;
Chung, Lo Woei ;
Liao, Yu-Mine ;
Bai, Li-Yuan ;
Chiu, Chang-Fang .
JOURNAL OF CLINICAL ONCOLOGY, 2008, 26 (15) :2584-2586
[10]  
Juneja Deven, 2012, J Intensive Care Med, V27, P373, DOI 10.1177/0885066611400277