Liver transplantation for patients with acute-on-chronic liver failure in Asia

Abstract

AIM: Acute-on-chronic liver failure (ACLF) is characterized by high mortality. Liver transplantation (LT) is effective in patients who do not improve with supportive measures. This study examines the outcome of ACLF patients who underwent LT in Asia. METHODS: Prospectively collected data from 17 Asian countries in the APASL ACLF Research Consortium was analyzed. 43 patients who underwent LT for ACLF were compared with 1657 non-transplanted ACLF patients. The variables analyzed include patient demographics, acute insult, background liver disease, severity scores (MELD and SOFA scores) and post-LT outcome. RESULTS: Mean age of LT patients was 42.1 years and non-transplanted patients was 43.7 years. 74.4 % of LT patients and 85.1 % of non-LT patients were male. The most common acute liver insult was HBV reactivation (24.4 %) in LT patients, compared with alcohol (49.5 %) in non-LT patients. Three-month survival rate was 76.7 % in LT group, and 52.6 % in non-LT group. Mean MELD scores prior to transplant was (27.7 ± 4.7) and (30.5 ± 8.3) in non-transplant group. In LT patients, baseline renal dysfunction predicted mortality (mean urea: 1.4 vs. 0.84 mg/dL, p = 0.015) (mean creatinine: 61 vs. 27 lmol/l, p = 0.042). High SOFA score was significantly associated with mortality in both LT (12.5 vs. 8, P = 0.015) and non-LT (8.3 vs. 10.9, p\0.001) patients. In non-LT patients, baseline urea (68.5 vs. 41.2 lmol/l, p\0.001), MELD (33.8 vs. 27.5, p\0.001) and Child-Pugh score (12 vs. 11, p\0.001) were independently associated with mortality. CONCLUSION: Baseline renal dysfunction and higher SOFA score predict poorer LT outcome in ACLF patients.