Living Donor Liver Transplantation for Acute on Chronic Liver Failure Based on EASL-CLIF Diagnostic Criteria

Abstract

LDLT has excellent outcomes in patients with EASL-CLIF grade 1 and 2 ACLF. Without transplantation, ACLF patients have a very poor prognosis.

Liver transplantation for acute-on-chronic liver failure

“…Nevertheless, due to organ shortage such decision should be evaluated on a case-by-case basis. The excellent outcome of patients who underwent living donor LT reported by different studies [33,34,55] may represent a turning point and reconsideration of living donation in the case of AoCLF patients.…”

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

“…According to the condition of ACLF patients with organ failure, EASL classifies the ACLF into three categories: ACLF 1: single organ kidney failure; or single failure of the liver, coagulation, respiration, and elevated creatinine of 1.5–1.9 mg/dl or hepatic encephalopathy (HE) ( 14 ) grade I or II; or HE grade III/IV and elevated creatinine of 1.5–1.9 mg/dl; ACLF 2: 2 organ failures; ACLF 3: ≥3 organ failures. Studies ( 21 ) have also validated EASL-CLIF grading in patients with cirrhosis. The 90-day mortality rate associated with ACLF 1–3 non-LT increased from 40.7 to 52.3 to 79.1%.…”

Current and future perspectives on acute-on-chronic liver failure: Challenges of transplantation, machine perfusion, and beyond

“…Living-donor liver transplantation (LDLT) could expand the donor organ pool and expedite transplantation in ACLF patients. Whilst studies in countries where deceased donors are scarce for cultural reasons demonstrated good LDLT postoperative outcomes[ 54 , 55 ], concerns regarding the prognosis of the sickest patients leading to stringent patient selection criteria hinder the applicability of this option thus far. In a retrospective analysis of 60 patients with EASL-CLIF grade 1 and 2 ACLF, LDLT transplanted patients exhibited a 1-year survival rate of 92% vs 11% in those who did not undergo transplantation[ 55 ].…”

“…Whilst studies in countries where deceased donors are scarce for cultural reasons demonstrated good LDLT postoperative outcomes[ 54 , 55 ], concerns regarding the prognosis of the sickest patients leading to stringent patient selection criteria hinder the applicability of this option thus far. In a retrospective analysis of 60 patients with EASL-CLIF grade 1 and 2 ACLF, LDLT transplanted patients exhibited a 1-year survival rate of 92% vs 11% in those who did not undergo transplantation[ 55 ]. In another retrospective study involving 218 ACLF patients, employing strict selection criteria -no high vasopressors or respiratory failure- for LDLT transplantation, the 1-year postoperative patient survival was 92.9% for EASL-CLIF grade 1, 85.4% for grade 2, and 75.6% for grade 3[ 54 ].…”