Pretransplant Neurological Presentation and Severe Posttransplant Brain Injury in Patients With Acute Liver Failure

Tan, Wen; Steadman, Randolph H.; Farmer, Douglas G.; Hong, Johnny C.; Busuttil, Ronald W.; Apinyachon, Worapot; Xia, Victor W.

doi:10.1097/tp.0b013e3182620596

Cited by 15 publications

(14 citation statements)

References 30 publications

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“…However, we did not detect a poorer long-term survival in APAP patients with more advanced encephalopathy at presentation. Nonetheless, other studies have demonstrated that severe cerebral oedema is predictive of poor neurological outcomes and survival in ALF patients (20,21).…”

Section: Discussionmentioning

confidence: 97%

Two‐year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study

Fontana

Ellerbe

Durkalski

et al. 2014

Liver International

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BACKGROUND The long-term clinical outcomes in initial survivors with acute liver failure (ALF) are not well known. AIMS The aim of the current study is to provide an overview of the 2 year clinical outcomes amongst initial survivors and liver transplant (LT) recipients that were alive 3 weeks after enrollment in the Acute Liver Failure Study Group (ALFSG). METHODS Outcomes in adult ALFSG patients that were enrolled between 1998 and 2010 were reviewed. RESULTS 2-year patient survival was significantly higher in the 262 LT recipients (92.4%) compared to the 306 acetaminophen (APAP) spontaneous survivors (SS) (89.5%) and 200 non-APAP SS (75.5%) (p < 0.0001). The causes of death were similar in the 3 groups but the time to death was significantly longer in the LT recipients (p< 0.0001). Independent predictors of 2-year mortality in the APAP group were a high serum phosphate level and patient age (c-statistic = 0.65 (0.54, 0.76)), patient age and days from jaundice to ALF onset in the non-APAP group (c-statistic =0.69 (0.60, 0.78)), and patient age, days from jaundice, and higher coma grade in the LT recipients (c-statistic=0.74 (0.61, 0.87)). The LT recipients were significantly more likely to be employed and have a higher educational level (p < 0.05). CONCLUSIONS Two-year outcomes in initial survivors of ALF are generally good but non-APAP patients have a significantly lower survival which may relate to pre-existing medical co-morbidities. Spontaneous survivors with APAP overdose experience substantial morbidity during follow-up from ongoing psychiatric and substance abuse issues.

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Section: Discussionmentioning

confidence: 97%

Two‐year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study

Fontana

Ellerbe

Durkalski

et al. 2014

Liver International

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“…ARI was defined as a 2‐fold or greater increase in the serum creatinine level in the first week after LT in comparison with the preoperative levels. ARI was analyzed after the exclusion of patients with pretransplant renal failure …”

Section: Methodsmentioning

confidence: 99%

Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

et al. 2014

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Donation after cardiac death (DCD) is an important source for expanding the donor pool for liver transplantation (LT).Although the long-term outcomes of LT using DCD grafts have been extensively studied, perioperative complications related to DCD grafts are rarely reported. The aim of this study was to determine whether DCD grafts were associated with a higher incidence of postreperfusion complications and worse outcomes in adult LT patients. After institutional review board approval, the medical records of all adult patients who underwent LT at our medical center between 2004 and 2011 were reviewed. Postreperfusion complications and posttransplant outcomes were compared between patients receiving DCD grafts and patients receiving donation after brain death (DBD) grafts. In all, 74 patients received DCD grafts during the study period, and 1369 patients received DBD grafts. An initial comparison showed that many preoperative, prereperfusion, and donor variables in the DCD group differed significantly from those in the DBD group. Propensity matching was chosen so that adjustments could be made for the differences. A postmatching analysis showed that the preoperative, prereperfusion, and donor variables no longer differed between the 2 groups. The postreperfusion requirements for blood products and vasopressors, the posttransplant ventilation times, the incidence of posttransplant acute renal injury, and the 30-day and 1-year patient and graft survival rates were comparable between the 2 groups. However, patients receiving DCD grafts experienced significantly higher rates of hyperkalemia (33.8% versus 18.9%, P < 0.05) and postreperfusion syndrome (PRS; 25.7% versus 12.3%, P < 0.05). In conclusion, after adjustments for preoperative and prereperfusion risks via propensity matching, DCD grafts remained a risk factor for postreperfusion hyperkalemia and PRS. A prophylactic regimen aimed at decreasing postreperfusion hyperkalemia and PRS is recommended for the management of LT using DCD grafts. Liver The demand for organs for liver transplantation (LT) continues to exceed the supply. The discrepancy between the number of available organs and the number of patients waiting for transplantation remains significant. 1 To address this urgent shortage and the rising wait-list mortality rate, the expansion of the donor pool through the use of donation after cardiac death (DCD) grafts has been promoted. 2 Although donation after brain death (DBD) remains the predominant source of deceased donor grafts, the use of DCD grafts in LT is being increasingly accepted worldwide. Now LT using DCD grafts accounts for approximately 5% of all Abbreviations: ARI, acute renal injury; BMI, body mass index; CIT, cold ischemia time; DBD, donation after brain death; DCD, donation after cardiac death; DWIT, donor warm ischemia time; FFP, fresh frozen plasma; GWIT, graft warm ischemia time; ICU, intensive care unit; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; PRS, postreperfusion syndrome; RBC, red blood cell; UCLA, Univer...

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“…Eight out of 61 (13%) had delayed awakening, requiring prolonged postoperative mechanical ventilation and the need of a tracheostomy. In DDLT for ALF, a relatively high incidence of recipient death due to encephalopathy has been reported . In contrast with LDLT, the reported rate of posttransplant mortality because of irreversible CE is low .…”

Section: Discussionmentioning

confidence: 99%

Living Donor Liver Transplantation for Acute Liver Failure: Donor Safety and Recipient Outcome

Pamecha¹,

Vagadiya²,

Sinha³

et al. 2019

Liver Transpl

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In countries where deceased organ donation is sparse, emergency living donor liver transplantation (LDLT) is the only lifesaving option in select patients with acute liver failure (ALF). The aim of the current study is living liver donor safety and recipient outcomes following LDLT for ALF. A total of 410 patients underwent LDLT between March 2011 and February 2018, out of which 61 (14.9%) were for ALF. All satisfied the King’s College criteria (KCC). Median admission to transplant time was 48 hours (range, 24‐80.5 hours), and median living donor evaluation time was 18 hours (14‐20 hours). Median Model for End‐Stage Liver Disease score was 37 (32‐40) with more than two‐thirds having grade 3 or 4 encephalopathy and 70% being on mechanical ventilation. The most common etiology was viral (37%). Median jaundice‐to‐encephalopathy time was 15 (9‐29) days. Preoperative culture was positive in 47.5%. There was no difference in the complication rate among emergency and elective living liver donors (13.1% versus 21.2%; P = 0.19). There was no donor mortality. For patients who met the KCC but did not undergo LT, survival was 22.8% (29/127). The 5‐year post‐LT actuarial survival was 65.57% with a median follow‐up of 35 months. On multivariate analysis, postoperative worsening of cerebral edema (CE; hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.01‐6.31), systemic inflammatory response syndrome (SIRS; HR, 16.7; 95% CI, 2.05‐136.7), preoperative culture positivity (HR, 6.54; 95% CI, 2.24‐19.07), and a longer anhepatic phase duration (HR, 1.01; 95% CI, 1.00‐1.02) predicted poor outcomes. In conclusion, emergency LDLT is lifesaving in selected patients with ALF. Outcomes of emergency living liver donation were comparable to that of elective donors. Postoperative worsening of CE, preoperative SIRS, and sepsis predicted outcome after LDLT for ALF.

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Pretransplant Neurological Presentation and Severe Posttransplant Brain Injury in Patients With Acute Liver Failure

Cited by 15 publications

References 30 publications

Two‐year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study

Two‐year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study

Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

Living Donor Liver Transplantation for Acute Liver Failure: Donor Safety and Recipient Outcome

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