Applicability of Liver Transplantation for Patients with Acute on Chronic Liver Failure

Abstract

Liver transplantation (LT) for acute on chronic liver failure (ACLF) may become the only chance to survive when other therapeutic measures fail. However, to reach a LT in this condition is difficult given its high short term mortality. Prevalence rates were reported between 24 to 34%.This data has not been described in our population Aim: to evaluate the prevalence and outcome of ACLF patients (pts) listed in our LT unit. Patients and Methods: Adults pts with chronic liver disease that were consecutive listed for LT between Jan/15 and Jun/16 were included and divided in two groups: ACLF and Non-ACLF. Age, gender, etiology of liver disease, presence of hepatocellular carcinoma, comorbid conditions, Child-Pugh and MELD, and pre and post LT outcome were compared on both groups. The chronic liver failure (CLIF) Consortium Organ Failure Score was used in the diagnosis and grading of ACLF, and the CLIF Consortium ACLF score (CLIF-C ACLF) was used to estimate probability of dying Results Prevalence of ACLF was 15%, 13 of 86 pts fulfilled ACLF criteria, 4 at the time of inclusion in the waiting list and 9 after 52 (13-360) days Precipitating events were bacterial infection (31%), gastrointestinal bleeding (15%), active alcoholism (8%), hemoperitoneum (8%) and non identified in the remaining 38%. Resolution of ACLF, access to LT or death for ACLF grade 1 (n=6) were 33%/50%/17%, for grade 2 (n=2) 0%,50%,100% and for grade 3 (n=5) 0%, 0%,100% respectively. The real waiting list mortality and the predicted by CLIF-C ACLF on ACLF pts at 28 days were 36%/42% and at 90 days 62%/56% (p=NS). Post-LT survival for non-ACLF/ACLF pts at 28, 90 and 180 days were 96%/75%, 92%/75% and 88%/75% (p=NS) Conclusions 1)Patients with ACLF grade 1 had the higher chance of resolution and / or transplantation 2) CLIF-C ACLF had a good correlation with the mortality found in this study 3) Post-LT survival was lower in pts with ACLF compared to non- ACLF, however, this difference was not statistically significant 4)More studies are required to define criteria to prioritize or reject the inclusion in the list of patients, according to the degree of ACLF