Acute Liver Failure Etiology Is an Independent Predictor of Waitlist Outcome but Not Posttransplantation Survival in a National Cohort.
Acute Liver Failure Etiology Is an Independent Predictor of Waitlist Outcome but Not Posttransplantation Survival in a National Cohort.
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DOI：
10.1002/lt.26187
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Bittermann T
中科院分区：
文献类型：
--
作者：
Wong NZ;Reddy KR;Bittermann T
急性肝功能衰竭(ALF)的病因对等待名单和移植后结果的影响，与疾病的严重程度无关，目前尚不完全清楚。所有在2002-2019年间因对乙酰氨基酚(APAP)、药物性肝损伤(DILI)、自身免疫性肝炎(AIH)和乙肝病毒(HBV)感染而行首次肝移植(LT)的成人(N=1,691人)都在器官共享联合网络数据库中进行了鉴定。ALF病因学被评估为等待名单死亡率和自发存活率(SS；相对于LT的结果)的独立预测因子，以及LT后的总体存活率、移植物存活率和住院死亡率的独立预测因子，使用多变量模型来解释列出的临床参数的差异。考虑到列表中疾病的严重程度，DILI、AIH和HBV3组的等待病死率和SS均低于APAP(在所有分析中，P<；均为0.001的调整后的相对风险比为1)。ALF病因与调整后的移植后总存活率(p=0.09)或移植物存活率(p=0.1)无关。肝移植术后住院死亡率高达9%。虽然ALF的病因也与调整后的住院死亡率无关(p=0.4)，但死亡原因(COD)是不同的。例如，肝移植后脑死亡发生率APAP为5.3%，其他DILI为3.0%，AIH为1.1%，HBV3.0%(p=0.02)。ALF病因学是等待治疗结果的独立预测因子，即使在调整了疾病的严重程度后也是如此，但除COD外，与肝移植后的治疗结果无关。所研究的所有ALF病因的肝移植后死亡大多发生在指数住院期间，这表明继续需要增强的预后工具以确保有效的器官利用，以及针对ALF和病因学的肝移植后护理以防止脑死亡。
The impact of acute liver failure (ALF) etiology on waitlist and post-transplant outcomes, independent of severity of illness is incompletely characterized. All adults (N=1,691) listed for primary liver transplantation (LT) between 2002–2019 with ALF due to acetaminophen (APAP), drug-induced liver injury (DILI), autoimmune hepatitis (AIH) and hepatitis B virus (HBV) were identified in the United Network for Organ Sharing database. ALF etiology was evaluated as an independent predictor of waitlist mortality and spontaneous survivorship (SS; versus outcome of LT), as well as post-LT overall survival, graft survival and in-hospital mortality using multivariable models that accounting for differences in clinical parameters at listing. Accounting for severity of illness at listing, waitlist mortality and SS for DILI, AIH and HBV were each lower than for APAP (adjusted relative risk ratio <1 in all analyses with p<0.001 for both outcomes). ALF etiology was not associated with adjusted overall survival post-LT (p=0.09) or graft survival (p=0.1). Inpatient mortality rate post-LT was high at 9%. While ALF etiology was also not associated with adjusted inpatient mortality (p=0.4), cause of death (COD) was different. For example, the rate of post-LT brain death was 5.3% for APAP, 3.0% for other DILI, 1.1% for AIH and 3.0% for HBV (p=0.02). ALF etiology is an independent predictor of waitlist outcome, even after adjusting for severity of illness, but is not associated with post-LT outcomes with the exception of COD. The majority of post-LT deaths for all ALF etiologies studied occurred during the index hospital stay, suggesting a continued need for enhanced prognostic tools to ensure efficient organ utilization, and ALF- and etiology-specific post-LT care to prevent brain death.
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影响因子：
8.8
作者：
Freeman, R. B., Jr.;Steffick, D. E.;Merion, R. M.
通讯作者：
Merion, R. M.
影响因子：
39.2
作者：
Reuben A;Tillman H;Fontana RJ;Davern T;McGuire B;Stravitz RT;Durkalski V;Larson AM;Liou I;Fix O;Schilsky M;McCashland T;Hay JE;Murray N;Shaikh OS;Ganger D;Zaman A;Han SB;Chung RT;Smith A;Brown R;Crippin J;Harrison ME;Koch D;Munoz S;Reddy KR;Rossaro L;Satyanarayana R;Hassanein T;Hanje AJ;Olson J;Subramanian R;Karvellas C;Hameed B;Sherker AH;Robuck P;Lee WM
通讯作者：
Lee WM
影响因子：
6.2
作者：
Barshes, NR;Lee, TC;Goss, JA
通讯作者：
Goss, JA
影响因子：
2.4
作者：
Hey, Penelope;Hanrahan, Timothy P.;Gow, Paul
通讯作者：
Gow, Paul
DOI：
10.1002/lt.24347
发表时间：
2016-04
期刊：
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
影响因子：
--
作者：
Reddy KR;Ellerbe C;Schilsky M;Stravitz RT;Fontana RJ;Durkalski V;Lee WM;Acute Liver Failure Study Group
通讯作者：
Acute Liver Failure Study Group