Stabilisation of acute-on-chronic liver failure patients before liver transplantation predicts post-transplant survival
Stabilisation of acute-on-chronic liver failure patients before liver transplantation predicts post-transplant survival
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DOI：
10.1111/apt.14627
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发表时间：
2018-06-01
影响因子：
7.6
通讯作者：
Fuhrmann, V
中科院分区：
文献类型：
--
作者：
Huebener, P.;Sterneck, M. R.;Fuhrmann, V
背景：慢性急性肝衰竭(ACLF)是肝硬变的一种严重并发症，与过高的短期死亡率相关。原位肝移植(OLT)对于急慢性肝衰竭患者来说是一种潜在的挽救生命的治疗方式，但选择移植后预后可接受的移植候选者是困难的。目的：评估ACLF患者的肝移植风险，并确定该患者队列中预测移植后存活的参数。方法：我们回顾分析了2009年至2014年在我所接受首次肝移植的250名肝硬化患者，并评估了移植后的结果。结果：在250名接受肝硬变的肝移植患者中，98名患者在移植前3个月内符合急慢性肝衰竭的诊断标准。与非急性肝功能衰竭患者相比，急性肝功能衰竭患者肝移植后的短期发病率和死亡率显著升高(90天存活率96.1%比72.4%，P<；0.0001)。在98名急慢性肝衰竭患者中，有37名患者在移植前的临床改善，主要是在确诊后的几天内。最值得注意的是，肝移植前的临床改善与移植后良好的存活率有关，与非ACLF移植受者相近。在移植后90天内，ACLF肝移植受者与非ACLF肝移植受者之间的患者存活率和长期移植物功能在长达5年的时间内是相似的。结论：急性/慢性肝衰竭预示着原位肝移植后的不良结局。然而，考虑到没有移植的预后不佳，我们的结果表明，ACLF患者可以移植而获得相对良好的结果，特别是在保守治疗措施下好转的患者。
Background: Acute-on-chronic liver failure (ACLF) is a severe complication of liver cirrhosis associated with excess short-term mortality rates. Orthotopic liver transplantation (OLT) is a potentially life-saving therapeutic modality for acute-on-chronic liver failure patients, but selection of transplant candidates with an acceptable post-transplant outcome is difficult.Aim: To assess the risk of liver transplantation in patients with ACLF, and to determine parameters that predict post-transplant survival in this patient cohort.Methods: We retrospectively analysed all 250 patients with cirrhosis who underwent their first liver transplantation between 2009 and 2014 at our institution, and assessed post-transplant outcomes.Results: Of 250 cirrhotic liver transplant recipients, 98 patients fulfilled the diagnostic criteria for acute-on-chronic liver failure in the 3-month pre-transplant period. Compared to non-ACLF patients, ACLF was associated with significantly higher short-term morbidity and mortality after liver transplantation (90-day patient survival 96.1% non-ACLF vs 72.4% ACLF patients, P < 0.0001). Clinical improvement in the pre-transplant period, as defined by recovery of at least one previously failed organ system, was observed in 37 of 98 acute-on-chronic liver failure patients, mostly within several days after diagnosis. Most notably, clinical improvement prior to liver transplantation was associated with excellent post-transplant survival rates that approximated non-ACLF transplant recipients. Following the 90-day post-transplant period, patient survival and long-term graft functions were comparable between ACLF and non-ACLF liver transplant recipients for up to 5 years.Conclusions: Acute-on-chronic liver failure predicts adverse outcome after orthotopic liver transplantation. Given the dismal prognosis without transplantation, however, our results indicate that ACLF patients can be transplanted with comparably good outcomes, in particular patients who improve under conservative therapeutic measures.