Patients With Acute on Chronic Liver Failure Grade 3 Have Greater 14‐Day Waitlist Mortality Than Status‐1a Patients

Sundaram, Vinay; Shah, Parth; Wong, Robert J.; Karvellas, Constantine J.; Fortune, Brett E.; Mahmud, Nadim; Kuo, Alexander; Jalan, Rajiv

doi:10.1002/hep.30624

Cited by 98 publications

(82 citation statements)

References 28 publications

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“…With the advancement of intensive care and organ failure supportive care, many studies recommend early recognition and transplant evaluation for patients with ACLF and advocate for additional priority on the waitlist. [7][8][9] Specific to HCV, the LT for HCC increased in the DAA era, while a decreased rate for Journal of Clinical and Translational Hepatology 2020 vol. 8 | 262-266 265 HCC-related LT was observed for ALD and NASH.…”

Section: Discussionmentioning

confidence: 99%

Changing Population of Liver Transplant Recipients in the Era of Direct-acting Antiviral Therapy

Xie

Kuo

Singal

2020

Journal of Clinical and Translational Hepatology

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Background and Aims: With the availability of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection and changing liver disease etiology for liver transplantation (LT), data on the changes in LT recipient population in the DAA era are scanty. Methods: The United Network for Organ Sharing (UNOS) registry (01/2007 to 06/2018) was used to develop a retrospective cohort of LT recipients for HCV, alcohol-associated liver disease (ALD), and non-alcoholic steatohepatitis (NASH). LT recipients in the DAA era (2013-2018) were compared with those in the pre-DAA era (2007-2012) era for recipient characteristics. Chi-square and analysis of variance were the statistical tests used for categorical and continuous variables, respectively. Results: Of 40,309 LT recipients (21,110 HCV, 7586 NASH, and 11,713 ALD), the 21,790 in the DAA era (9432 HCV, 7240 ALD, and 5118 NASH) were more likely to be older, female, obese, diabetic, have acute-onchronic liver failure with a higher model for end-stage liver disease score, receive grafts with a lower donor risk index, and have waited on the LT list for a shorter period compared with their pre-DAA era counterparts. Specific to ALD, LT recipients with alcohol hepatitis were more likely to be younger at the time of LT. Of 9895 LT recipients with hepatocellular carcinoma, recipients in the DAA era were observed to have a higher proportion of HCV (43% vs. 32%, p<0.001), a lower proportion of ALD (9% vs. 12%, p<0.001), and no change for NASH (13% vs. 13%, p=0.9) compared with the pre-DAA era. Within the hepatocellular carcinoma population, LT recipients in the DAA era were older, diabetic, and waited on the LT list longer compared with their pre-DAA counterparts. Conclusions: Along with changing liver disease etiology in the DAA era, the LT recipient population demographics, comorbidities, liver disease severity, and graft quality are changing. These changes are relevant for future studies, immunosuppression, and post-transplant follow-up.

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Section: Discussionmentioning

confidence: 99%

Changing Population of Liver Transplant Recipients in the Era of Direct-acting Antiviral Therapy

Xie

Kuo

Singal

2020

Journal of Clinical and Translational Hepatology

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“…New prognostic models and scoring systems for patients with ACLF have been developed that perform better than the MELD score and suggest that patients with ACLF are served poorly by the current organ allocation system. The results of these developments are helping to bring about discussions regarding changes to the organ allocation policies Development of new guidelines of care: Recognizing the devastating outcome of ACLF, a Consensus meeting, endorsed by the American Society of Transplantation, the American Society of Transplant Surgeons, and EASL, was organized.…”

Section: Impact Of Recognition Of Aclf As a New Syndromementioning

confidence: 99%

Acute‐on‐Chronic Liver Failure: A New Disease or an Old One Hiding in Plain Sight?

Jalan

Moreau

Arroyo

et al. 2020

Clinical Liver Disease

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“…Similar to the MELD‐Na score, the NACSELD‐ACLF score is excellent in predicting short‐term mortality, but organ failures themselves do not necessarily indicate a poor posttransplant prognosis. In fact, patients meeting criteria for ACLF on the LT waiting list had higher mortality than those with acute liver failure, which was previously thought to confer the highest short‐term mortality for patients with liver disease . In contrast to non‐LT centers, LT centers should be incentivized to continue to consider patients with multiple organ failures for LT, especially when patients derive significant short‐term and longterm survival benefit from LT .…”

Section: Discussionmentioning

confidence: 99%

The North American Consortium for the Study of End‐Stage Liver Disease–Acute‐on‐Chronic Liver Failure Score Accurately Predicts Survival: An External Validation Using a National Cohort

et al. 2020

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Acute-on-chronic liver failure (ACLF) carries high short-term mortality. The North American Consortium for the Study of End-Stage Liver Disease (NACSELD)-ACLF score, positive if ≥2 organ failures are present, is a bedside tool that predicts short-term mortality in patients with cirrhosis. However, it was created using major liver referral centers, where a minority of patients with cirrhosis are hospitalized. Therefore, this study used the Nationwide Inpatient Sample, a nationally representative database, from 2005 to 2014 to externally validate the NACSELD-ACLF score in a cohort of patients with decompensated cirrhosis who were identified by a validated algorithm. Organ failures were identified using diagnosis codes. The primary objective was to evaluate the association between the NACSELD-ACLF score and inpatient mortality, whereas secondary objectives compared outcomes depending on presence of infection or hospitalization at a transplant center. Multivariate logistic regression was used to compare outcomes, and area under the curve was calculated. There were 1,523,478 discharges that were included with 106,634 (7.0%) having a positive NACSELD-ACLF score. Patients were a mean 58 years old, and a majority were white men. Infection was present in 33.7% of the sample. Inpatient survival decreased with each organ failure and if infection was present. Patients with the NACSELD-ACLF score had significantly lower inpatient survival on crude (94% versus 48%; P < 0.001) and multivariate analysis (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.07-0.08) and area under the receiver operating characteristic curve 0.77 (95% CI, 0.77-0.78). Liver transplant centers had clinically similar but significantly better survival at each organ failure, in patients with the NACSELD-ACLF score, and on multivariate analysis (OR, 1.17; 95% CI, 1.13-1.22). Using a national cohort, our study validated the NACSELD-ACLF score as an excellent, simple bedside tool to predict short-term survival in patients with decompensated cirrhosis. 26 187-195 2020 AASLD. Liver Transplantation

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Patients With Acute on Chronic Liver Failure Grade 3 Have Greater 14‐Day Waitlist Mortality Than Status‐1a Patients

Cited by 98 publications

References 28 publications

Changing Population of Liver Transplant Recipients in the Era of Direct-acting Antiviral Therapy

Changing Population of Liver Transplant Recipients in the Era of Direct-acting Antiviral Therapy

Acute‐on‐Chronic Liver Failure: A New Disease or an Old One Hiding in Plain Sight?

The North American Consortium for the Study of End‐Stage Liver Disease–Acute‐on‐Chronic Liver Failure Score Accurately Predicts Survival: An External Validation Using a National Cohort

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