Dynamic Prognostication in Transplant Candidates with Acute-on-Chronic Liver Failure.

Cheng-Yueh Lu,Po-Huang Lee,Chih-Yang Hsiao,Cheng-Maw Ho,Rey-Heng Hu,Yao-Ming Wu,Ming-Chih Ho,Chi-Ling Chen

doi:10.3390/jpm10040230

Abstract

We aimed to extensively investigate clinical markers that are sufficiently dynamic for prognosis of acute-on-chronic liver failure (ACLF). Defined by the Asian Pacific Association for the Study of the Liver (APASL) criteria, patients with ACLF on the liver transplant waitlist in a tertiary center were retrospectively reviewed. Laboratory results and severity scores at three time points (days 1, 7, and 14 after admission) were analyzed. From 2015 to 2019, 64 patients with ACLF were enrolled, of which 24 received a liver transplant from 22 live donors. The hospital mortality rate was 31% (8% for transplant; 45% for nontransplant groups), and the 3-month survival was crucial for determining long-term outcomes. The number of significant variables for mortality, and, specifically, the hazards of international normalized ratio of prothrombin time (INR) and APASL ACLF Research Consortium (AARC) score were increased within two weeks. In multivariable analysis, INR and AARC score (D-14) were associated with poor survival and liver transplant was a protective factor in all patients, while AARC score (D-14) was significant in the nontransplant group. AARC score at day 14 is an independent risk factor for mortality in ACLF. Liver transplant from live donors reversed poor outcomes in patients with ACLF in a timely manner.

Highlights

Acute-on-chronic liver failure (ACLF) is a clinical syndrome manifesting as acute and severe hepatic dysfunction in patients with chronic liver disease caused by various insults [1]
The diagnosis of ACLF was based on the criteria formalized by the ACLF consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL), defined as the presence of acute hepatic insult, jaundice, and coagulopathy (international normalized ratio (INR) ≥1.5) complicated by ascites or encephalopathy or both within 4 weeks, with previously diagnosed or undiagnosed chronic liver disease [6,11,12]
The Model for End-Stage Liver Disease (MELD) and ACLF Research Consortium (AARC) scores were similar between the transplant and nontransplant groups, patients with ACLF who received a liver transplant had poorer clinical and laboratory profiles

Summary

Introduction

Acute-on-chronic liver failure (ACLF) is a clinical syndrome manifesting as acute and severe hepatic dysfunction in patients with chronic liver disease caused by various insults [1]. Acute precipitants include infection (systemic nonviral infection or via hepatotropic viruses), toxins (alcohol or drugs), and bleeding, whereas the underlying chronic liver disease (generally cirrhosis) can be due to hepatitis B or C virus (HBV or HCV) infection, alcohol, or nonalcoholic steatohepatitis or be of autoimmune or cryptogenic origin [1,2,3]. Spectrum heterogeneity influences patient prognosis, all patients with ACLF have high short-term mortality [4]. This important issue warrants investigation, and experiences from centers worldwide should be evaluated [2]

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