Artificial Liver Support System Combined with Liver Transplantation in the Treatment of Patients with Acute-on-Chronic Liver Failure

Xiao Xu,Qiang Wei,Min Zhang,Shusen Zheng,Jifang Sheng,Xiaoli Liu,Jianrong Huang,Lanjuan Li,Lin Zhou,Qi Ling,Xiaowei Xu,Zhikun Liu,Jian Wu,Kwan Man

doi:10.1371/journal.pone.0058738

Abstract

BackgroundThe search for a strategy to provide temporary liver support and salvage the patients with acute-on-chronic liver failure (ACLF) remains an important issue. This study was designed to evaluate the experience in artificial liver support system (ALSS) combined with liver transplantation (LT) in the treatment of ACLF.Methodology/Principal FindingsOne hundred and seventy one patients with HBV related ACLF undergoing LT between January 2001 and December 2009 were included. Of the 171 patients, 115 received 247 sessions of plasma exchange-centered ALSS treatment prior to LT (ALSS-LT group) and the other 56 received emergency LT (LT group). The MELD score were 31±6 and 30±7 in ALSS-LT group and LT group. ALSS treatment resulted in improvement of liver function and better tolerance to LT. The average level of serum total bilirubin before LT was lower than that before the first time of ALSS treatment. The median waiting time for a donor liver was 12 days (2–226 days) from the first run of ALSS treatment to LT. Compared to LT group, the beneficial influences of ALSS on intraoperative blood loss and endotracheal intubation time were also observed in ALSS-LT group. The 1-year and 5-year survival rates in the ALSS-LT group and LT group were 79.2% and 83%, 69.7% and 78.6%.Conclusions/SignificancePlasma exchange-centered ALSS is beneficial in salvaging patients with ACLF when a donor liver is not available. The consequential LT is the fundamental treatment modality to rescue these patients and lead to a similar survival rate as those patients receiving emergency transplantation.

Highlights

Liver failure remains a disease associated with high mortality
3.1 Efficacy of artificial liver support system (ALSS) Before ALSS treatment, 115 patients in ALSS-liver transplantation (LT) group were in poor general condition, complicated by cachexia, fatigue, loss of appetite, abdominal distention, jaundice, hepatorenal syndrome or hepatic encephalopathy
As the only efficient procedure to treat acute-on-chronic liver failure (ACLF), LT has been applied with a perioperative mortality rate of less 3% and 1-year survival rate of exceeding 80% for recipients in some major transplant centers in China [9]

Summary

Introduction

Liver failure remains a disease associated with high mortality. According to Asian Pacific Association for the Study of the Liver, ACLF has been recently defined as ‘acute hepatic insult manifesting as jaundice and coagulopathy, complicated within 4 weeks by ascites and/or encephalopathy in a patient with previously diagnosed or undiagnosed chronic liver disease [1]. Liver transplantation (LT) is the best treatment for salvaging patients with ACLF. Enormous attempts at providing temporary liver support have been made, with an aim to increase survival rate or improve the condition of the patient until a donor is available. The search for a strategy to provide temporary liver support and salvage the patients with acute-on-chronic liver failure (ACLF) remains an important issue. This study was designed to evaluate the experience in artificial liver support system (ALSS) combined with liver transplantation (LT) in the treatment of ACLF

Methods

Results

Conclusion