Type of organ failure and acute insult have important bearings in outcomes of liver transplantation: A pragmatic discourse

Roy, Akash; Taneja, Sunil

doi:10.1016/j.jhep.2018.09.010

Cited by 2 publications

(1 citation statement)

References 7 publications

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“…This cohort cannot compare with large registries in terms of the number of patients included but it does have the granularity that registries lack, in particular concerning PaO 2 /FiO 2 ratios that typically go unrecorded in registries. 24 Mechanical ventilation with PaO 2 /FiO 2 ratio ≤200 mm Hg was associated with a 40-point increase in mortality compared to the rest of the patients in the entire cohort (64.5% vs 24.8%, respectively). The effect of respiratory failure is therefore probably incremental: mechanical ventilation alone (eg, for encephalopathy) affects post-LT outcome moderately whereas mechanical ventilation with low PaO 2 /FiO 2 ratio affects it drastically.…”

Section: Post-lt Mortality Model With Continuous Variablesmentioning

confidence: 86%

Liver transplantation for critically ill cirrhotic patients: Stratifying utility based on pretransplant factors

Artzner

Michard

Weiss

et al. 2020

American Journal of Transplantation

104

108

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The aim of this study was to produce a prognostic model to help predict posttransplant survival in patients transplanted with grade‐3 acute‐on‐chronic liver failure (ACLF‐3). Patients with ACLF‐3 who underwent liver transplantation (LT) between 2007 and 2017 in 5 transplant centers were included (n = 152). Predictors of 1‐year mortality were retrospectively screened and tested on a single center training cohort and subsequently tested on an independent multicenter cohort composed of the 4 other centers. Four independent pretransplant risk factors were associated with 1‐year mortality after transplantation in the training cohort: age ≥53 years (P = .044), pre‐LT arterial lactate level ≥4 mml/L (P = .013), mechanical ventilation with PaO2/FiO2 ≤ 200 mm Hg (P = .026), and pre‐LT leukocyte count ≤10 G/L (P = .004). A simplified version of the model was derived by assigning 1 point to each risk factor: the transplantation for Aclf‐3 model (TAM) score. A cut‐off at 2 points distinguished a high‐risk group (score >2) from a low‐risk group (score ≤2) with 1‐year survival of 8.3% vs 83.9% respectively (P < .001). This model was subsequently validated in the independent multicenter cohort. The TAM score can help stratify posttransplant survival and identify an optimal transplantation window for patients with ACLF‐3.

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Section: Post-lt Mortality Model With Continuous Variablesmentioning

confidence: 86%

Liver transplantation for critically ill cirrhotic patients: Stratifying utility based on pretransplant factors

Artzner

Michard

Weiss

et al. 2020

American Journal of Transplantation

104

108

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Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis

et al. 2021

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Background Acute decompensation (AD) of liver cirrhosis (LC) and subsequent acute-on-chronic liver failure (ACLF) are fatal and impair quality of life. Insufficient knowledge of the highly heterogeneous natural history of LC, including decompensation, re-compensation, and possible recurrent decompensation, hinders the development and application of novel therapeutics. Approximately 10%-50% of AD/ACLF is reported to be precipitated by any indeterminate (unidentifiable, cryptogenic, or unknown) acute insults; however, its clinical characteristics are unclear. Methods We conducted a single-center observational study of 2165 consecutively admitted patients with LC from January 2012 to December 2019. A total of 466 episodes of AD/ACLF in 285 patients, including their 285 first indexed AD/ACLF, were extracted for analysis. Stratified analyses of different acute precipitants, classified as indeterminate (AD/ACLFIND), bacterial infection (AD/ACLFBAC), gastrointestinal bleeding, active alcoholism, and miscellaneous, were performed. Results AD/ACLFIND was the leading acute precipitant (28%), followed by AD/ACLFBAC (23%). AD/ACLFIND showed better survival outcomes than AD/ACLFBAC (P = 0.03); however, hyperbilirubinemia, hyponatremia, or leukocytosis significantly and uniquely characterized subgroups of AD/ACLFIND with comparable or even worse survival outcomes than those of AD/ACLFBAC. Patients with subsequent AD/ACLF significantly tended to suffer from AD/ACLF with any organ failure in AD/ACLFIND but not in AD/ACLFBAC (P = 0.004, for trend). In competing risk analysis, patients with AD/ACLFIND were significantly more vulnerable to suffer from recurrent episodes of AD/ACLF within 180 days, compared to those triggered by other precipitants (P = 0.04). Conclusions AD/ACLFIND, the leading acute precipitant, also plays a role in subsequent AD/ACLF. An abruptly exacerbating, remitting, and relapsing nature of systemic inflammation underlying AD/ACLF may also be useful for risk estimation.

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Type of organ failure and acute insult have important bearings in outcomes of liver transplantation: A pragmatic discourse

Cited by 2 publications

References 7 publications

Liver transplantation for critically ill cirrhotic patients: Stratifying utility based on pretransplant factors

Liver transplantation for critically ill cirrhotic patients: Stratifying utility based on pretransplant factors

Vulnerability to recurrent episodes of acute decompensation/acute-on-chronic liver failure characterizes those triggered by indeterminate precipitants in patients with liver cirrhosis

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