Liver transplantation in the most severely ill cirrhotic patients: A multicenter study in acute-on-chronic liver failure grade 3
Liver transplantation in the most severely ill cirrhotic patients: A multicenter study in acute-on-chronic liver failure grade 3
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DOI：
10.1016/j.jhep.2017.06.009
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发表时间：
2017-10-01
影响因子：
25.7
通讯作者：
Saliba, Faouzi
中科院分区：
文献类型：
--
作者：
Artru, Florent;Louvet, Alexandre;Saliba, Faouzi
背景和目标：肝移植（LT）治疗最严重的肝硬化患者，多器官功能障碍（准确评估急性慢性肝功能衰竭[ACLF]分类）仍然存在争议。我们的目的是报告的结果，LT患者ACLF 3级，并比较这些患者的非移植肝硬化和多器官功能障碍患者，以及移植ACLF等级较低的患者。方法：所有患者ACLF-3移植在三个肝脏重症监护病房（ICU）进行了回顾性研究。每个ACLF-3患者与a）在ICU住院的多器官功能障碍的非移植患者或B）移植有较低ACLF等级的对照患者（三组）相匹配。这些重症患者在入院后9天（平均器官衰竭从4.03进展至3.67，p = 0.009）接受了移植治疗，以稳定病情。ACLF-3移植患者的一年生存率高于非移植对照组：83.9% vs. 7.9%，p
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