Transplantation within 7 days of listing boosts survival in acute-on-chronic liver failure
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LONDON — Early liver transplantation within 7 days of listing was linked to improved 90-day and 1-year survival among patients with grade 3 acute-on-chronic liver failure, according to data presented at the International Liver Congress.
“Currently, the ideal time frame between listing and liver transplantation to achieve optimal patient outcome in [grade 3 acute-on-chronic liver failure] is not known,” Joseph J. Alukal, MD, of Platinum Hospitalists and Spring Valley Hospital Medical Center in Nevada, told Healio.
To determine whether early LT affects 90-day and 1-year survival among grade 3 acute-on-chronic liver failure (ACLF-3) patients, Alukal and colleagues examined the United Network for Organ Sharing (UNOS) database to identify patients with ACLF-3 who underwent LT from 2005 to 2021. Using EASL-CLIF criteria, they identified 3,498 patients who had early transplantation and 1,485 who had a transplant more than 7 days from listing.
Researchers excluded those listed as status 1, 1A or 1B, as well as those with multi-organ transplant, living donor transplant and hepatocellular carcinoma, and evaluated patient survival with unadjusted Kaplan-Meier survival curves. They assessed risk factors using the Cox proportional hazards.
According to study results, ACLF-3 patients who were transplanted less than 7 days after listing exhibited improved 90-day (92%) and 1-year survival (87%) compared with those who underwent transplantation more than 7 days after listing (83.5%; P = .001).
“Our research shows that patients with ACLF-3 who have a liver transplant within 7 days of listing have better 1-year post-transplant survival compared to the late transplant group,” Alukal said. “More importantly, this survival benefit is seen across all subgroups of ACLF-3, including those with four, five and six organ failures.”
On multivariable analysis, researchers reported that age (HR = 1.02), body mass index (HR = 1.01), donor risk index (>1.7, HR = 1.3), respiratory failure (HR = 1.9) and etiology of cirrhosis were independent predictors of higher 90-day post-transplant mortality.
“When we adjusted for risk, we found that patients who undergo late transplantation — between days 8 and 28 — have a 20% increased risk for mortality,” Alukal said. “Based on our study, carefully selected ACLF-3 patients should be evaluated for rapid liver transplant, irrespective of the number of organ failures.
“[However,] we need prospective, multicenter studies that can corroborate our results from the UNOS database, [as well as] studies to find out risk factors in ACLF-3 patients that exclude them from undergoing transplant.”
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Alukal JJ. Abstract OS061. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).
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