Liver transplantation for acute liver failure – a 30-year single center experience

Sars, Carl; Tranäng, Marie; Ericzon, Bo‐Göran; Berglund, Erik

doi:10.1080/00365521.2018.1477986

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…This improvement in survival rate over the last decade parallels the increase in the number of LDLTs performed in the US [ 22 , 23 , 24 ]. This can also be explained by improvements in surgical techniques, organ preservation, and graft survival over the past decade [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Recipient Survival among Living Donor vs. Deceased Donor Liver Transplants for Acute Liver Failure in the United States

Moughames,

Gurakar,

Khan

et al. 2024

JCM

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Objectives: Acute liver failure (ALF) is associated with high morbidity and mortality. Timely liver transplantation (LT) is the only universally accepted therapy for ALF that is non-responsive to medical therapy. Data regarding the use of living donor LT (LDLT) for this indication in the US is scarce. Materials and Methods: United Network of Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) data from January 2002 to December 2020 were reviewed. Adult and pediatric recipients listed as status 1 were included. Demographics, clinical and laboratory data, and post-LT survival rates were compared for LDLT vs. DDLT recipients. Results: There were 180 LDLT (3.6%) and 4779 DDLT (96.4%) recipients with a diagnosis of ALF. The majority of recipients in the LDLT group were pediatric (n = 164, 91%) compared to the DDLT group (n = 1455, 30%), p < 0.001. In the pediatric-only group, post-LT survival was comparable between LDLT and DDLT recipients (p = 0.15). Five-year post-LT survival was higher for pediatric recipients compared to adults in the LDLT group (84.2% vs. 62.5%, respectively, p < 0.001) and the DDLT group (82.8% vs. 78.7%, respectively, p < 0.001). Adults had a higher hazard of death compared to pediatric recipients in the LDLT group (HR = 3.560, 95% CI 1.612–7.844, p = 0.002) and the DDLT group (HR = 1.472, 95% CI 1.290–1.679, p < 0.001). In multivariate analysis results, the type of LT and age group were not associated with higher post-LT mortality. Conclusions: In the US, LDLT constitutes 3.6% of LTs for ALF. In the pediatric-only group, post-LT survival was comparable between LDLT and DDLT recipients. Overall, there were superior post-LT outcomes for pediatric recipients compared to adults for LDLT and DDLT.

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Section: Discussionmentioning

confidence: 99%

Recipient Survival among Living Donor vs. Deceased Donor Liver Transplants for Acute Liver Failure in the United States

Moughames,

Gurakar,

Khan

et al. 2024

JCM

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“…Outcomes with medical management alone – at least for some causes of ALF – are now excellent, and there is need for revised criteria to select ELT candidates who reflect current medical outcomes. Although survival after ELT is excellent [79], medically managed patients may have better long-term outcomes [80]. In the United Kingdom, the original KCC have been replaced with the UK revised criteria (UKRC) (Table 4), which on independent validation outperformed the original KCC with high sensitivity and specificity, whilst utilizing readily available clinical variables [81,82].…”

Section: Prognostic Assessment and Liver Transplantationmentioning

confidence: 99%

Acute liver failure

Vasques

Cavazza

Bernal

2022

Current Opinion in Critical Care

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Purpose of reviewPresent an outline of acute liver failure, from its definition to its management in critical care, updated with findings of selected newer research. Recent findingsSurvival of patients with acute liver failure has progressively improved. Intracranial hypertension complicating hepatic encephalopathy is now much less frequent than in the past and invasive ICP monitoring is now rarely used. Early renal replacement therapy and possibly therapeutic plasma exchange have consolidated their role in the treatment. Further evidence confirms the low incidence of bleeding in these patients despite striking abnormalities in standard tests of coagulation and new findings of abnormalities on thromboelastographic testing. Specific coagulopathy profiles including an abnormal vWF/ADAMTS13 ratio may be associated with poor outcome and increased bleeding risk. Use of Nacetylcysteine in nonparacetamol-related cases remains unsupported by robust clinical evidence. New microRNA-based prognostic markers to select patients for transplantation are described but are still far from widespread clinical applicability; imaging-based prognostication tools are also promising. The use of extracorporeal artificial liver devices in clinical practice is yet to be supported by evidence. SummaryMedical treatment of patients with acute liver failure is now associated with significantly improved survival. Better prognostication and selection for emergency liver transplant may further improve care for these patients.

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“…The 1- and 5-year post-LT survival rates are 79% and 72% in Europe and 84% and 73% in the United States, respectively[ 6 , 62 ]. In a recent study based on 30-year single-center experience from Sweden, the 1-year, 5-year, 10-year, and 20-year post-LT survival rates in ALF patients were 71%, 63%, 52%, and 40%, respectively[ 63 ]. Between 2000 and 2014, the survival rates were even better (1 year-82%, 5 years-76%, and 10 years-71%).However, 1-year post-LT survival rate is still approximately 10% lower for ALF patients than for other transplanted non-ALF patients[ 6 , 62 - 64 ].…”

Section: Post-transplant Outcomesmentioning

confidence: 99%

Liver transplantation in acute liver failure: Dilemmas and challenges

Kumar¹,

Anand²,

Priyadarshi³

2021

WJT

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Acute liver failure (ALF) refers to a state of severe hepatic injury that leads to altered coagulation and sensorium in the absence of pre-existing liver disease. ALF has different causes, but the clinical characteristics are strikingly similar. In clinical practice, however, inconsistency in the definition of ALF worldwide and confusion regarding the existence of pre-existing liver disease raise diagnostic dilemmas. ALF mortality rates used to be over 80% in the past; however, survival rates on medical treatment have significantly improved in recent years due to a greater understanding of pathophysiology and advances in critical care management. The survival rates in acetaminophen-associated ALF have become close to the post-transplant survival rates. Given that liver transplantation (LT) is an expensive treatment that involves a major surgical operation in critically ill patients and lifelong immunosuppression, it is very important to select accurate patients who may benefit from it. Still, emergency LT remains a lifesaving procedure for many ALF patients. However, there is a lack of consistency in current prognostic models that hampers the selection of transplant candidates in a timely and precise manner. The other problems associated with LT in ALF are the shortage of graft, development of contraindications on the waiting list, vaguely defined delisting criteria, time constraints for pre-transplant evaluation, ethical concerns, and comparatively poor post-transplant outcomes in ALF. Therefore, there is a desperate need to establish accurate prognostic models and explore the roles of evolving adjunctive and alternative therapies, such as liver support systems, plasma exchange, stem cells, auxiliary LT, and so on, to enhance transplant-free survival and to fill the void created by the graft shortage

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Liver transplantation for acute liver failure – a 30-year single center experience

Cited by 8 publications

References 18 publications

Recipient Survival among Living Donor vs. Deceased Donor Liver Transplants for Acute Liver Failure in the United States

Recipient Survival among Living Donor vs. Deceased Donor Liver Transplants for Acute Liver Failure in the United States

Acute liver failure

Liver transplantation in acute liver failure: Dilemmas and challenges

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