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Liver transplantation in the most severely ill cirrhotic patients: A multicenter study in acute-on-chronic liver failure grade 3
- Source :
- Journal of Hepatology, Journal of Hepatology, Elsevier, 2017, 67 (4), pp.708--715. ⟨10.1016/j.jhep.2017.06.009⟩
- Publication Year :
- 2016
-
Abstract
- International audience; BACKGROUND & AIMS: Liver transplantation (LT) for the most severely ill patients with cirrhosis, with multiple organ dysfunction (accurately assessed by the acute-on-chronic liver failure [ACLF] classification) remains controversial. We aimed to report the results of LT in patients with ACLF grade 3 and to compare these patients to non-transplanted patients with cirrhosis and multiple organ dysfunction as well as to patients transplanted with lower ACLF grade. METHODS: All patients with ACLF-3 transplanted in three liver intensive care units (ICUs) were retrospectively included. Each patient with ACLF-3 was matched to a) non-transplanted patients hospitalized in the ICU with multiple organ dysfunction, or b) control patients transplanted with each of the lower ACLF grades (three groups). RESULTS: Seventy-three patients were included. These severely ill patients were transplanted following management to stabilize their condition with a median of nine days after admission (progression of mean organ failure from 4.03 to 3.67, p=0.009). One-year survival of transplanted patients with ACLF-3 was higher than that of non-transplanted controls: 83.9 vs. 7.9%, p\textless0.0001. This high survival rate was not different from that of matched control patients with no ACLF (90%), ACLF-1 (82.3%) or ACLF-2 (86.2%). However, a higher rate of complications was observed (100 vs. 51.2 vs. 76.5 vs. 74.3%, respectively), with a longer hospital stay. The notion of a "transplantation window" is discussed. CONCLUSIONS: LT strongly influences the survival of patients with cirrhosis and ACLF-3 with a 1-year survival similar to that of patients with a lower grade of ACLF. A rapid decision-making process is needed because of the short "transplantation window" suggesting that patients with ACLF-3 should be rapidly referred to a specific liver ICU. Lay summary: Liver transplantation improves survival of patients with very severe cirrhosis. These patients must be carefully monitored and managed in a specialized unit. The decision to transplant a patient must be quick to avoid a high risk of mortality.
- Subjects :
- Liver Cirrhosis
Male
medicine.medical_specialty
Cirrhosis
Time Factors
Critical Care
[SDV]Life Sciences [q-bio]
medicine.medical_treatment
Liver transplantation
law.invention
03 medical and health sciences
0302 clinical medicine
law
Intensive care
Internal medicine
medicine
Humans
Intensive care unit
Referral and Consultation
Survival analysis
Retrospective Studies
Hepatology
business.industry
Organ dysfunction
Acute-On-Chronic Liver Failure
Retrospective cohort study
Middle Aged
medicine.disease
Prognosis
Survival Analysis
Surgery
Liver Transplantation
Multi-organ dysfunction
Transplantation
030220 oncology & carcinogenesis
Case-Control Studies
030211 gastroenterology & hepatology
Female
France
medicine.symptom
business
Subjects
Details
- ISSN :
- 16000641 and 01688278
- Volume :
- 67
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of hepatology
- Accession number :
- edsair.doi.dedup.....74c1f457e9fc19808a87a446397ef324
- Full Text :
- https://doi.org/10.1016/j.jhep.2017.06.009⟩