Liver transplantation in Acute-on-Chronic liver failure: Timing of transplantation and selection of patient population

Li, Xue; Zhang, Liang; Pu, Chunmei; Tang, Shanhong

doi:10.3389/fmed.2022.1030336

Cited by 7 publications

(5 citation statements)

References 61 publications

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“…Transplant is the only ultimate standard therapy for severe ACLF that does not rely on liver regeneration for clinical improvement; 1-year post-transplant survival has been shown to be over 80% regardless of ACLF grade, and is better among transplant recipients compared to non-recipients[ 36 , 37 ]. However, patient selection is crucial given the narrow window for transplant[ 38 , 39 ]. Several studies have examined pre-transplant predictors to prognosticate post-transplant survival in ACLF[ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of fungal vs bacterial infections in the medical intensive liver unit: Cause or corollary for high mortality?

Khan,

Hong,

Bass

et al. 2024

World J Hepatol

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BACKGROUND Due to development of an immune-dysregulated phenotype, advanced liver disease in all forms predisposes patients to sepsis acquisition, including by opportunistic pathogens such as fungi. Little data exists on fungal infection within a medical intensive liver unit (MILU), particularly in relation to acute on chronic liver failure. AIM To investigate the impact of fungal infections among critically ill patients with advanced liver disease, and compare outcomes to those of patients with bacterial infections. METHODS From our prospective registry of MILU patients from 2018-2022, we included 27 patients with culture-positive fungal infections and 183 with bacterial infections. We compared outcomes between patients admitted to the MILU with fungal infections to bacterial counterparts. Data was extracted through chart review. RESULTS All fungal infections were due to Candida species, and were most frequently blood isolates. Mortality among patients with fungal infections was significantly worse relative to the bacterial cohort (93% vs 52%, P < 0.001). The majority of the fungal cohort developed grade 2 or 3 acute on chronic liver failure (ACLF) (90% vs 64%, P = 0.02). Patients in the fungal cohort had increased use of vasopressors (96% vs 70%, P = 0.04), mechanical ventilation (96% vs 65%, P < 0.001), and dialysis due to acute kidney injury (78% vs 52%, P = 0.014). On MILU admission, the fungal cohort had significantly higher Acute Physiology and Chronic Health Evaluation (108 vs 91, P = 0.003), Acute Physiology Score (86 vs 65, P = 0.003), and Model for End-Stage Liver Disease-Sodium scores (86 vs 65, P = 0.041). There was no significant difference in the rate of central line use preceding culture (52% vs 40%, P = 0.2). Patients with fungal infection had higher rate of transplant hold placement, and lower rates of transplant; however, differences did not achieve statistical significance. CONCLUSION Mortality was worse among patients with fungal infections, likely attributable to severe ACLF development. Prospective studies examining empiric antifungals in severe ACLF and associations between fungal infections and transplant outcomes are critical.

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Section: Discussionmentioning

confidence: 99%

Comparison of fungal vs bacterial infections in the medical intensive liver unit: Cause or corollary for high mortality?

Khan,

Hong,

Bass

et al. 2024

World J Hepatol

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“…PE is widely used in China and other Asia-Pacific countries. It can remove toxic substances from the bodies of patients within the appropriate timeframe and reduce liver inflammation [22]. At the same time, it also supplements plasma proteins and coagulation factors, which can not only reduce edema and bleeding in patients but also reduce the chance of infection and facilitate the repair and regeneration of liver cells.…”

Section: Discussionmentioning

confidence: 99%

PLT Counts as a Predictive Marker after Plasma Exchange in Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Li¹,

Li²,

Zhu³

et al. 2023

JCM

Self Cite

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Background and Objectives: The platelet (PLT) value in hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) is not sufficiently understood. The present study aimed to evaluate the prognostic effect of PLT on the prediction of HBV-ACLF outcomes after plasma exchange (PE). Methods: HBV-ACLF patients treated with PE between January 2017 and August 2021 were followed up for at least 6 months. Cox regression was performed to develop the predictive model, and the model’s performance was analyzed using the receiver operating characteristic curve (ROC). Results: A total of 170 patients were included. The overall survival rate within 180 days was 75.88%. Age, PLT, total bilirubin (TBil), and the iMELD scores were independent risk factors affecting the prognosis of HBV-ACLF patients after PE. According to the Cox regression results, the new model was calculated: R = 0.142 × iMELD-0.009 × PLT. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) was 0.758 (95% CI 0.678–0.838), and patients with lower PLT-iMELD scores (<4.50) had a better prognosis (p < 0.001). Conclusion: PLT is a valuable prognostic biomarker for HBV-ACLF patients after PE. The modified iMELD model incorporating PLT has a better sensitivity and efficacy in predicting the prognosis of patients.

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“…In the literature, liver transplantation in ACLF has been studied in retrospective series with contrasting results. Indeed, post liver transplantation survival rates for ACLF-3 vary from 52 to 93% at 1 year [ 2 , 10 , 11 , 12 , 13 , 14 , 15 ]. Among the largest series published in the literature, the French multicenter study of Artru et al involving 73 patients transplanted with ACLF-3 showed interesting results [ 12 ].…”

Section: Liver Transplantation In Aclfmentioning

confidence: 99%

“…Liver transplantation in ACLF has been reported in retrospective series and registries with contrasting results. Post-liver transplantation survival rates for ACLF-3 varied from 52 to 93% at 1 year [ 2 ]. These differences are probably related to differences in patient selection and centers experience in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

How to Optimize the Results of Liver Transplantation for Acute-on-Chronic Liver Failure

Sacleux

Saliba

2023

Life

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Cirrhotic patients who developed a decompensation episode requiring an admission to an intensive care unit are not equal in term of prognosis. This led to the definition of a syndrome, acute-on-chronic liver failure (ACLF), marked by the severity of systemic inflammation, the development of organ failures and a high short-term mortality. The most common underlying liver etiology is related to acute alcohol hepatitis in western countries and to HBV or HCV cirrhosis in eastern countries. Twenty-eight and 90-days high mortality rates are well linked to the number of organ failure and defined, merely ten years ago, by a modified SOFA score. ACLF is a dynamic syndrome and grading can vary from hospital admission. ACLF grading between day 3–7 of admission is more accurate for determining outcome. ACLF-3 patients with ≥3 organ failures remain very challenging with >75% mortality rate. Despite recent advances in the medical management of critically ill cirrhotic patients, the prognosis of these patients remains poor. Currently, the main effective treatment is an urgent liver transplantation (LT) which is performed in a very selected patients eligible to transplant given the limited availability of organ donors and the low post-transplant survival rates reported in earlier studies. Recently, large retrospective multicenter studies and registries showed an improved 1-year post-transplant survival rate >83% in several transplant centers. Nevertheless, only few proportions of the ACLF-2 and ACLF-3 patients are transplanted representing 0–10% of most liver transplant programs. A careful selection of these patients (excluding major comorbidities i.e., older age, addictology criteria, severe malnutrition…) and optimal timing for transplant (infection control, hemodynamic stability, low oxygen and vasopressor requirements) are associated with excellent post-transplant survival rate.

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Liver transplantation in Acute-on-Chronic liver failure: Timing of transplantation and selection of patient population

Cited by 7 publications

References 61 publications

Comparison of fungal vs bacterial infections in the medical intensive liver unit: Cause or corollary for high mortality?

Comparison of fungal vs bacterial infections in the medical intensive liver unit: Cause or corollary for high mortality?

PLT Counts as a Predictive Marker after Plasma Exchange in Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

How to Optimize the Results of Liver Transplantation for Acute-on-Chronic Liver Failure

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