Liver transplantation for acute liver failure and acute-on-chronic liver failure

Kulkarni, Anand V.; Gustot, Thierry; Reddy, K. Rajender

doi:10.1016/j.ajt.2024.07.012

American Journal of Transplantation

2024

DOI: 10.1016/j.ajt.2024.07.012

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Liver transplantation for acute liver failure and acute-on-chronic liver failure

Anand V. Kulkarni,

Thierry Gustot,

K. Rajender Reddy

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Acute Liver Failure Etiology Determines Long-Term Outcomes in Patients Undergoing Liver Transplantation: An Analysis of the UNOS Database

Amaris,

Marenco-Flores,

Barba

et al. 2024

JCM

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Background: Acute liver failure (ALF) involves rapid liver injury, often leading to multi-organ failure. Liver transplantation (LT) has improved survival rates, with U.S. rates reaching 92%. This study analyzes UNOS data (2002–2020) to evaluate long-term survival and identify risk factors affecting waitlist and post-LT outcomes in ALF patients. Methods: A retrospective analysis was performed on adult ALF patients waitlisted for LT (Status 1/1A). ALF etiologies, including viral infections, drug-induced liver injury (DILI), acetaminophen (APAP) overdose, autoimmune hepatitis (AIH), Wilson disease (WD), and unknown causes, were assessed with patient and donor characteristics. Kaplan–Meier and Cox regression analyses identified predictors of patient and graft survival. Sensitivity analysis confirmed the model’s robustness. Results: We identified 2759 ALF patients. APAP (HR 1.7; p < 0.001) and unknown etiology (HR 1.3; p = 0.037) were linked to higher waitlist removal risk, while WD (HR 0.36; p < 0.001) increased LT probability. Among 2014 LT recipients, WD showed improved survival (HR 0.53; p = 0.002). Black/African American race (HR 1.47; p < 0.001), diabetes (HR 1.81; p < 0.001), and encephalopathy (HR 1.27; p < 0.001) predicted higher mortality. AIH had the lowest 1- and 10-year survival (83% and 62%), while APAP had the lowest 5-year survival (76%). WD had the highest graft survival at 1, 5, and 10 years (93%, 88%, and 80%). Conclusions: ALF etiology significantly affects survival outcomes. AIH and APAP are associated with worse survival, while WD shows favorable outcomes. Tailored post-LT management is essential to improve survival in ALF patients.

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Acute Liver Failure Etiology Determines Long-Term Outcomes in Patients Undergoing Liver Transplantation: An Analysis of the UNOS Database

Amaris,

Marenco-Flores,

Barba

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

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Liver transplantation for acute liver failure and acute-on-chronic liver failure

Cited by 1 publication

References 117 publications

Acute Liver Failure Etiology Determines Long-Term Outcomes in Patients Undergoing Liver Transplantation: An Analysis of the UNOS Database

Acute Liver Failure Etiology Determines Long-Term Outcomes in Patients Undergoing Liver Transplantation: An Analysis of the UNOS Database

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