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Outcomes After Listing for Liver Transplant in Patients With Acute‐on‐Chronic Liver Failure: The Multicenter North American Consortium for the Study of End‐Stage Liver Disease Experience
Author(s) -
O’Leary Jacqueline G.,
Bajaj Jasmohan S.,
Tandon Puneeta,
Biggins Scott W.,
Wong Florence,
Kamath Patrick S.,
GarciaTsao Guadalupe,
Maliakkal Benedict,
Lai Jennifer,
Fallon Michael,
Vargas Hugo E.,
Thuluvath Paul,
Subramanian Ram,
Thacker Leroy R.,
Reddy K. Rajender
Publication year - 2019
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25426
Subject(s) - medicine , liver transplantation , model for end stage liver disease , cirrhosis , liver disease , dialysis , creatinine , chronic liver disease , gastroenterology , kidney disease , hepatorenal syndrome , transplantation , perioperative , stage (stratigraphy) , renal replacement therapy , surgery , paleontology , biology
Acute‐on‐chronic liver failure (ACLF) characterized with ≥2 extrahepatic organ failures in cirrhosis carries a high mortality. Outcomes of patients listed for liver transplantation (LT) after ACLF and after LT are largely unknown. The North American Consortium for the Study of End‐Stage Liver Disease prospectively enrolled 2793 nonelectively hospitalized patients with cirrhosis; 768 were listed for LT. Within 3 months, 265 (35%) received a LT, 395 remained alive without LT, and 108 died/delisted. Compared with nonlisted patients, those listed were younger and more often had ACLF, acute kidney injury, and a higher admission Model for End‐Stage Liver Disease (MELD) score. ACLF was most common in patients who died/delisted, followed by those alive with and without LT respectively, (30%, 22%, and 7%, respectively; P < 0.001). At LT, median MELD was 27.9% and 70% were inpatients; median time from hospitalization to LT was 26 days. Post‐LT survival at 6 months was unchanged between those with and without ACLF (93% each at 6 months). There was no difference in 3‐ and 6‐month mean post‐LT creatinine in those with and without ACLF, despite those with ACLF having a higher mean pre‐LT creatinine and a higher rate of perioperative dialysis (61%). In conclusion, patients with and without ACLF had similar survival after transplant with excellent renal recovery in both groups.