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Liver transplantation in the most severely ill cirrhotic patients: A multicenter study in acute-on-chronic liver failure grade 3

Authors :
Sébastien Dharancy
Astrid Herrerro
Gilles Lebuffe
Eleonora De Martin
Philippe Mathurin
Julien Labreuche
Philippe Ichai
Samir Jaber
Teresa Antonini
Isaac Ruiz
Eric Levesque
Didier Samuel
Alain Duhamel
Georges-Philippe Pageaux
Emmanuel Boleslawski
Alexandre Louvet
Faouzi Saliba
Eric Kipnis
Florent Artru
Guillaume Lassailly
José Ursic-Bedoya
Audrey Coilly
Eric Vibert
Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
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.

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⟩