Liver Transplantation Within 7-Days of Listing Improves Survival in ACLF-3

Background and Aims Patients with acute on chronic liver failure (ACLF-3) have a very high short-term mortality without liver transplantation (LT). Our objective was to determine whether early LT (ELT; ≤ 7 days from listing) had an impact on 1 year patient (PS) in patients with ACLF-3 compared to late LT (LLT; days 8–28 from listing). Methods All adults with ACLF-3 listed for LT with the United Network for Organ Sharing (UNOS) between 2005 and 2021 were included. We excluded status one patients and those with liver cancer or listed for multi-organ or living donor transplants. ACLF patients were identified using the European Association for the Study of the Liver-Chronic Liver Failure criteria. Patients were categorized as ACLF-3a and ACLF-3b. Results During the study period, 7607 patients were listed with ACLF-3 (3a-4520, 3b-3087); 3498 patients with ACLF-3 underwent ELT and 1308 had LLT. The overall 1 year PS after listing was 64.4% in ACLF-3a and 50% in ACLF-3b. In 4806 ACLF-3 patients who underwent LT, 1 year PS was 86.2%, but those who had ELT had higher survival (87.1 vs. 83.6%, P = 0.001) than the LLT group. These survival benefits were seen in both ACLF-3a and ACLF-3b. On multivariable analysis, age (HR 1.02, CI 1.01–1.03), diabetes (HR 1.40, CI 1.16–1.68), respiratory failure (HR 1.76, CI 1.50–2.08), donor risk index > 1.7 (HR 1.24, CI 1.06–1.45), and LLT (HR 1.20, CI 1.02–1.43) were independent predictors of higher 1 year mortality while higher albumin (HR 0.89, CI 0.80–0.98) was associated with reduced mortality. Conclusion Early LT (≤ 7 days from listing) in ACLF-3 is associated with better 1 year survival compared to late LT (days 8–28 from listing)..

Medienart:

E-Artikel

Erscheinungsjahr:

2023

Erschienen:

2023

Enthalten in:

Zur Gesamtaufnahme - volume:68

Enthalten in:

Digestive diseases and sciences - 68(2023), 8 vom: 21. Juni, Seite 3268-3276

Sprache:

Englisch

Beteiligte Personen:

Alukal, Joseph J. [VerfasserIn]
Li, Feng [VerfasserIn]
Thuluvath, Paul J. [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.87$jGastroenterologie

Themen:

ACLF
Liver transplant within 7 days
Liver transplantation

Anmerkungen:

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:

10.1007/s10620-023-08011-2

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2144504709

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