Liver transplantation improves survival in patients with acute-on-chronic liver failure

Select patients with acute-on-chronic liver failure who underwent liver transplantation experienced improved survival, according to study results.

“Liver transplantation [LT] has been proposed as a treatment option for [acute-on-chronic liver failure (ACLF)], however, data are heterogeneous and scanty on the LT for ACLF,” Ashwani K. Singal, MD, of University of South Dakota Sanford School of Medicine, and colleagues wrote. “Furthermore, there are no defined selection criteria for ACLF patients due to lack of randomized or high-quality prospective studies on LT in these patients.”

Researchers performed a meta-analysis to compare outcomes after LT for ACLF with patients with ACLF not receiving LT or among LT recipients for indications other than ACLF.

Their analysis included nine studies comprising 22,238 patients who underwent LT for ACLF and 30,791 patients who underwent LT for non-ACLF conditions.

Investigators found that post-transplant survival in ACLF was lower at 30 days (96.2% vs. 98.1%), 90 days (92.6% vs. 96.2%), 6 months (89.9% vs. 94.4%), 1 year (86% vs. 91.9%) and 5 years (66.9% vs. 80.7%; all P < .01).

While they had similar post-transplant complications, patients with ACLF had longer hospitalizations (5.7 days longer) and longer stays in the intensive care unit (10.5 days longer).

In three studies, Singal and colleagues found that patients who underwent LT for ACLF had better 30-day and 1-year survival than patients with ACLF who did not receive LT (95.2% vs. 60% and 85.3% vs. 28.2%, respectively; both P < .001). Patients with ACLF-1 or 2 at the time of transplantation had better outcomes than patients with ACLF-3.

Singal and colleagues wrote that their findings show that patients with ACLF selected for LT have better outcomes than patients with ACLF who do not receive a transplant.

“However, transplanted ACLF patients had worse outcomes compared to LT for indications other than ACLF,” they wrote. “Future, well-designed, large-scale, prospective, multicentric studies with long-term follow-up are needed as basis for developing guidelines and criteria for patient selection for LT among patients with ACLF.”