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

Jacqueline G. O’Leary, Jasmohan S. Bajaj, Puneeta Tandon, Scott W. Biggins, Florence Wong, Patrick S. Kamath, Guadalupe Garcia-Tsao, Benedict Maliakkal, Jennifer Lai, Michael Fallon, Hugo E. Vargas, Paul Thuluvath, Ram Subramanian, Leroy R. Thacker, K. Rajender Reddy

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)571-579
Number of pages9
JournalLiver Transplantation
Volume25
Issue number4
DOIs
StatePublished - Apr 2019
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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    O’Leary, J. G., Bajaj, J. S., Tandon, P., Biggins, S. W., Wong, F., Kamath, P. S., Garcia-Tsao, G., Maliakkal, B., Lai, J., Fallon, M., Vargas, H. E., Thuluvath, P., Subramanian, R., Thacker, L. R., & Reddy, K. R. (2019). 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. Liver Transplantation, 25(4), 571-579. https://doi.org/10.1002/lt.25426