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Researchers find ACLF assessment may determine urgency for LT

In patients with acute-on-liver failure enrolled in the CANONIC study, researchers found that following the course of the disease after diagnosis could be a useful tool in determining the need for liver transplant, according to study data.

Researchers analyzed data of 388 patients who had acute-on-liver failure (ACLF) at enrollment, from February to September 2011 or during 28-day follow-up. The researchers measured different grades of ACLF at various time points to determine resolution, improvement, worsening, or steady or fluctuating course of the disease.

“This would help in identifying conditions either requiring early admission to ICU, organ support treatment and urgent [liver transplant], or rendering current medical interventions futile, and provide a rational basis for designing future studies on ACLF therapy,” the researchers wrote.

Study results showed that ACLF either improved or resolved in 49.2% of patients, was steady or fluctuated in 30.4% and worsened in 20.4% of patients. Patients with nonsevere ACLF or grade 1 had a lower 28-day transplant-free mortality rate (between 6-18%) compared with patients with grade 2 or 3 ACLF (between 42-92%).

Chronic Liver Failure Consortium (CLIF-C) ACLF score (OR = 1.11; 95% CI, 1.07-1.15) and liver failure at ACLF diagnosis (OR = 2.82; 95% CI, 1.72-4.63) were independent predictors of severe early course (P < .0001 for both).

“Eighty-one percent of patients had their final ACLF grade at 1 week, resulting in accurate prediction of short- (28-day) and mid-term (90-day) mortality by ACLF grade [3 to 7 days after diagnosis],” the researchers wrote.

Of the patients who underwent early LT, 75% survived for at least 1 year. One-hundred percent of patients who had at least four organ failures or CLIF-C ACLFs greater than 64 3 to 7 days after diagnosis of ACLF, and did not undergo liver transplant, died by 28 days.

“[3 to 7 days after diagnosis of] ACLF could be a good assessment to define the need and timing of potential LT,” the researchers wrote. “In the same manner, the number of organ failures and CLIF-C ACLFs at days 3 to 7 after ACLF-3 diagnosis could provide a rational basis for discontinuation of intensive care owing to futility.” – by Melinda Stevens

Disclosures: Gustot reports no relevant financial disclosures. Please see the study for a full list of all other authors’ relevant financial disclosures.