Living Donor Liver Transplantation in a Hepatitis B Patient with Acute on Chronic Liver Failure Accompanying Hepatocellular Carcinoma

SummaryBackgroundData on liver transplantation (LT) in acute on chronic liver failure (ACLF) are scanty.AimTo perform meta‐analysis on outcomes after LT for ACLF compared with ACLF patients not receiving LT or with LT recipients for indications other than ACLF.MethodsWe pooled data from 12 studies on LT outcomes among ACLF patients.ResultsAmong nine studies, 22 238 LT recipients for ACLF vs 30 791 for non‐ACLF were younger by 1.1 years, less males (64% vs 66.4%), and higher model for end‐stage disease score by 14.5 (14.4‐14.6), P < 0.01 for all. Post‐transplant patient survival at 30 day, 90 day, 6 months, 1 year and 5 years was lower in ACLF: 96.2% vs 98.1%, 92.6% vs 96.2%, 89.9% vs 94.4%, 86.0% vs 91.9%, 66.9% vs 80.7% respectively, P < 0.01 for all. ACLF patients stayed longer in hospital and ICU by 5.7 and 10.5 days respectively, P < 0.001, with similar post‐transplant complications [74.4% vs 55.5%, P = 0.12]. Among three studies, 441 LT recipients for ACLF vs 301 ACLF patients not selected for LT had better 30 day and 1 year survival: 95.2% vs 60% and 85.3% vs 28.2% respectively, P < 0.001. Outcomes were worse in ACLF‐3 and better for ACLF‐1 and ACLF‐2 patients at the time of LT.ConclusionIn this pooled analysis with a large sample size across the globe, LT for select patients with ACLF provided survival benefit. However, larger prospective studies are needed to further refine selection criteria, especially for ACLF‐3 patients as basis for improving outcomes and optimal utilisation of scarce donor pool.

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Systematic review with meta‐analysis: liver transplant provides survival benefit in patients with acute on chronic liver failure

Abdallah¹,

Waleed²,

Bell³

et al. 2020

Aliment Pharmacol Ther

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Living Donor Liver Transplantation in a Hepatitis B Patient with Acute on Chronic Liver Failure Accompanying Hepatocellular Carcinoma

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Systematic review with meta‐analysis: liver transplant provides survival benefit in patients with acute on chronic liver failure

Systematic review with meta‐analysis: liver transplant provides survival benefit in patients with acute on chronic liver failure

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