Longterm Outcomes of Patients Undergoing Liver Transplantation for Acute‐on‐Chronic Liver Failure

Sundaram, Vinay; Mahmud, Nadim; Perricone, Giovanni; Katarey, Dev; Wong, Robert J.; Karvellas, Constantine J.; Fortune, Brett E.; Rahimi, Robert S.; Maddur, Haripriya; Jou, Janice H.; Kriss, Michael; Stein, Lance L.; Lee, Moses; Jalan, Rajiv

doi:10.1002/lt.25831

Cited by 50 publications

(50 citation statements)

References 27 publications

(40 reference statements)

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“…Strikingly, lethal infections constituted the predominant threat to ACLF‐LT recipients not only in the first 6 months, but also during the remainder of the follow‐up. Similar observations regarding patient survival and infectious complications were recently reported from an UNOS database analysis of >50 000 LT recipients, despite substantial differences between both cohorts in terms of cirrhosis aetiology and LT recipient age 12 . The severity of ACLF thus emerges as an important predictor of post‐LT complications in suitable transplant candidates, independently of baseline patient characteristics and affiliation to a particular allocation system.…”

Section: Discussionsupporting

confidence: 79%

“…We recently reported on the positive impact of clinical stabilization of ACLF patients prior to LT on short‐term post‐transplant survival 10 . Our findings were generally confirmed in a large patient cohort from the UNOS database, 11 however, effects of pretransplant ACLF on aspects of post‐transplant medical care that exceed sheer survival are incompletely understood 12 . Here, we assessed the effects of ACLF on long‐term post‐transplant survival, graft function, patient morbidity and quality of life (QoL).…”

Section: Introductionsupporting

confidence: 60%

“…A large fraction of ACLF patients exhibit contraindications for LT such as severe comorbidities, active alcoholism or ongoing infection 4,5 . More recent analyses, however, have indicated that in select ACLF patients, LT is feasible with comparably good results, 6,8,12 particularly in patients who experience clinical stabilization prior to surgery 10,11 . Among patients with persistent ACLF grade 3, who are at highest risk of death without LT, the identification of suitable LT candidates remains challenging.…”

Section: Discussionmentioning

confidence: 99%

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Liver transplantation for acute‐on‐chronic liver failure predicts post‐transplant mortality and impaired long‐term quality of life

Goosmann

Buchholz

Bangert

et al. 2020

Liver International

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Background Among patients with cirrhosis, candidate selection and timing of liver transplantation (LT) remain problematic. Acute‐on‐chronic liver failure (ACLF) is a severe complication of cirrhosis with excessive short‐term mortality rates under conservative therapeutic measures. The role of LT in the management of ACLF is uncertain. Objective To assess the impact of ACLF on post‐LT survival and long‐term graft function, morbidity and quality of life (QoL). Methods We retrospectively analysed all cirrhosis patients undergoing LT at our institution between 01/2009 and 12/2014. Median follow‐up was 8.7 years. Long‐term LT survivors were interviewed with established QoL questionnaires. Results Of 250 LT recipients, 98 fulfilled the EASL diagnostic ACLF criteria before LT (‘ACLF‐LT’). ACLF associated with reduced post‐LT survival (HR for 6‐month survival compared to non‐ACLF‐LT: 0.18; HR for 10‐year‐survival: 0.47; both P < .001) depending on ACLF severity before LT, and mainly inferred by infections both in the early and late phases after LT. In ACLF patients, CLIFc‐OFs was superior to MELD score in predicting post‐LT mortality. Long‐term follow‐up revealed comparable graft functions and comorbidity burden in ACLF‐LT and non‐ACLF‐LT survivors. ACLF‐LT patients reported significantly impaired health and QoL, particularly with regards to anxiety/depression and physical and psychological health (all P < .05). LabMELD score, presence of ACLF at LT and duration of post‐LT intensive care associated with poor long‐term QoL. Conclusion ACLF predicts impaired post‐LT survival. While long‐term graft function and extrahepatic comorbidities are comparable in ACLF and non‐ACLF LT survivors, the strikingly low QoL in many ACLF‐LT recipients warrants consideration during follow‐up patient care.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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Liver transplantation for acute‐on‐chronic liver failure predicts post‐transplant mortality and impaired long‐term quality of life

Goosmann

Buchholz

Bangert

et al. 2020

Liver International

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“…Patients with acute liver failure or ACLF are susceptible to infection, and early transplant-free survival is poor [ 126 , 127 , 128 , 129 ]. In liver transplantation for patients with ACLF, the role of the timing, bridging, and management of liver transplantation is important [ 130 , 131 ].…”

Section: Prevention Of Hav Infection In Patients With Chronic LIVmentioning

confidence: 99%

Co-Occurrence of Hepatitis A Infection and Chronic Liver Disease

Sasaki

Masuzaki

Takahashi

et al. 2020

IJMS

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Hepatitis A virus (HAV) infection occasionally leads to a critical condition in patients with or without chronic liver diseases. Acute-on-chronic liver disease includes acute-on-chronic liver failure (ACLF) and non-ACLF. In this review, we searched the literature concerning the association between HAV infection and chronic liver diseases in PubMed. Chronic liver diseases, such as metabolic associated fatty liver disease and alcoholic liver disease, coinfection with other viruses, and host genetic factors may be associated with severe hepatitis A. It is important to understand these conditions and mechanisms. There may be no etiological correlation between liver failure and HAV infection, but there is an association between the level of chronic liver damage and the severity of acute-on-chronic liver disease. While the application of an HAV vaccination is important for preventing HAV infection, the development of antivirals against HAV may be important for preventing the development of ACLF with HAV infection as an acute insult. The latter is all the more urgent given that the lives of patients with HAV infection and a chronic liver disease of another etiology may be at immediate risk.

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“…( 8 ) Encouragingly, survival rates in patients receiving LT after 2012 were significantly better than before. ( 9 )…”

mentioning

confidence: 99%

Liver Transplantation in Acute‐on‐Chronic Liver Failure Is a Wise Longterm Investment

Trebicka

Belli²

2020

Liver Transpl.

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Longterm Outcomes of Patients Undergoing Liver Transplantation for Acute‐on‐Chronic Liver Failure

Cited by 50 publications

References 27 publications

Liver transplantation for acute‐on‐chronic liver failure predicts post‐transplant mortality and impaired long‐term quality of life

Liver transplantation for acute‐on‐chronic liver failure predicts post‐transplant mortality and impaired long‐term quality of life

Co-Occurrence of Hepatitis A Infection and Chronic Liver Disease

Liver Transplantation in Acute‐on‐Chronic Liver Failure Is a Wise Longterm Investment

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