Editorial: Transplantation in the cirrhotic patient with multiorgan failure: Adding more pieces to an incomplete puzzle

Sundaram, Vinay

doi:10.1111/ajt.15927

Cited by 2 publications

(2 citation statements)

References 4 publications

(9 reference statements)

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“…The TAM score, which was recently published, (10,11) was specifically designed to identify patients with ACLF-3 with particularly poor post-LT prognosis to help clinicians decide whether a patient who is critically ill with cirrhosis is too sick to receive a transplant at the time of organ proposal. The TAM score was derived from the analysis of the largest multicenter granular cohort of patients with ACLF-3 who received a transplant published so far.…”

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confidence: 99%

Pretransplant Intensive Care Unit Management and Selection of Grade 3 Acute‐on‐Chronic Liver Failure Transplant Candidates

Michard¹,

Artzner²,

Deridder³

et al. 2021

Liver Transpl.

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The aim of this study is to report on the liver transplantation (LT) activity and posttransplant outcome, over time, of patients with grade 3 acute-on-chronic liver failure (ACLF-3) in a single transplant center performing a large number of LTs for patients with ACLF-3. It aims at showing how pre-LT intensive care unit (ICU) management impacts post-LT outcomes, in particular through monitoring the transplantation for ACLF-3 model (TAM) score. A total of 100 patients who had ACLF-3 at the time of LT between 2007 and 2019 were included retrospectively. The cohort was divided in 2 periods, with 50 patients in each period. There was an increase in the number of patients with ACLF-3 who received an LT during the course of the study period and significantly higher 1-year post-LT survival rates in the second period compared with the first period (86% versus 66%, respectively; P = 0.02). Interestingly, patients during both periods had similar severity profiles and scores apart from a significantly lower number of patients with TAM scores >2 at the time of LT in the second period compared with the first period (1 [2%] versus 11 [22%], respectively; P ≤ 0.01). In addition, patients whose clinical condition improved in the ICU (with a TAM score downstaged between admission and LT) had significantly higher post-LT survival rates than those whose TAM score stayed the same or increased: 88% versus 70%, respectively (P = 0.04). This study shows a learning curve in LT for patients with ACLF-3, with optimized ICU management and patient selection leading to increased numbers of LTs for patients with ACLF-3 and improved post-LT outcomes. It also delineates how the TAM score can be used to identify the optimal transplantability window for patients with ACLF-3.

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confidence: 99%

Pretransplant Intensive Care Unit Management and Selection of Grade 3 Acute‐on‐Chronic Liver Failure Transplant Candidates

Michard¹,

Artzner²,

Deridder³

et al. 2021

Liver Transpl.

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“… 1 , 2 Liver transplantation is the main treatment for ACLF and can significantly improve the prognosis. 3 However, given the shortage of liver sources, the risks associated with liver transplantation, and the high medical costs, risk stratification of patients with ACLF is a key imperative. Many evaluation methods have been developed to assess the risk of ACLF progression.…”

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confidence: 99%

Development of a Widely Applicable and Simple Prognostic Score for Patients with Acute-on-chronic Liver Failure

Yu¹,

Li²,

Zhou³

et al. 2022

J Clin Transl Hepatol

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Background and Aims Acute-on-chronic liver failure (ACLF) tends to progress rapidly with high short-term mortality. We aimed to create a widely applicable, simple prognostic (WASP) score for ACLF patients. Methods A retrospective cohort of ACLF cases recruited from three centers in China were divided into training and validation sets to develop the new score. A prospective longitudinal cohort was recruited for further validation. Results A total of 541 cases were included in the training set, and seven independent ACLF prognostic factors were screened to construct a new quantitative WASP-ACLF table. In the validation set of 671 cases, WASP-ACLF showed better predictive ability for 28-day and 90-day mortality than the currently used prognostic scores at baseline, day 3, week 1, and week 2. The predictive efficacy and clinical validity of the model improved over time. Patients were assigned to low-, intermediate-, and high-risk groups by their WASP-ACLF scores. Compared with the other two groups, intermediate-risk patients had a more uncertain prognosis, with a 90-day mortality of 44.4–50.6%. Sequential assessments at weeks 1 and 2 found the 90-day mortality of intermediate-risk groups was <20% for patients with a ≥2 point decrease in WASP-ACLF and was up to 56% for patients with a ≥2 points increase. Similar results were observed in prospective data. Conclusions The new ACLF prognostic score was simple, widely applicable, and had good predictive efficacy. Continuous assessments and trend of change in WASP-ACLF need to be considered, especially for intermediate-risk patients.

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Editorial: Transplantation in the cirrhotic patient with multiorgan failure: Adding more pieces to an incomplete puzzle

Abstract: This editorial discusses predictors of mortality after liver transplantation and a newly developed scoring system to determine transplant futility in patients with severe acute‐on‐chronic liver failure. See the article by Artzner et al on page 2437.

Cited by 2 publications

References 4 publications

Pretransplant Intensive Care Unit Management and Selection of Grade 3 Acute‐on‐Chronic Liver Failure Transplant Candidates

Pretransplant Intensive Care Unit Management and Selection of Grade 3 Acute‐on‐Chronic Liver Failure Transplant Candidates

Development of a Widely Applicable and Simple Prognostic Score for Patients with Acute-on-chronic Liver Failure

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