Ashok Choudhury1,2, Rajan Vijayaraghavan1,2, Rakhi Maiwall1,2, Manoj Kumar1,2, Zhongping Duan3, Chen Yu3, Saeed Sadiq Hamid4, Wasim Jafri4, Amna Subhan Butt4, Harshad Devarbhavi5, Qin Ning6, Ke Ma6, Soek-Siam Tan7, Akash Shukla8, Radhakrishna Dhiman9, Ajay Duseja9, Sunil Taneja9, C E Eapen10, Ashish Goel10, Sombat Treeprasertsuk11, Mamun Al-Mahtab12, Hasmik Ghazinyan13, Dong Joon Kim14, Manoj K Sahu15, Guan Huei Lee16, Laurentius A Lesmana17, Rinaldi Cosmas Lesmana17, Samir Shah18, Zaigham Abbas19, Jose D Sollano20, P N Rao21, Anand Kulkarni21, Gamal Shiha22, Ananta Shrestha23, AKadir Dokmeci24, Man Fung Yuen25, Diana Alcantara Payawal26, Kemal Fariz Kalista27, V G Mohan Prasad28, George K Lau29, Fazal Karim30, Priyanka Jain31, Guresh Kumar31, Vinod Arora1,2, Viniyendra Pamecha32,33, Piyush Sinha32,33, Shiv K Sarin34,35. 1. Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. 2. Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India. 3. Translational Hepatology Institute Capital Medical University, Beijing You'an Hospital, Beijing, China. 4. Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan. 5. Department of Gastroenterology and Hepatology, St John Medical College, Bangalore, India. 6. Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 7. Department of Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia. 8. Department of Hepatology, KEM Hospital and Seth GSMC, Mumbai, India. 9. Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 10. Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India. 11. Department of Medicine, Chulalongkorn University, Bangkok, Thailand. 12. Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. 13. Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia. 14. Centre for Liver and Digestive Diseases, Gangwon-Do, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea. 15. Department of Gastroenterology and Biliary Sciences, IMS and SUM Hospital, Bhubaneswar, Odisha, India. 16. Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore. 17. Department of Medicine, Medistra Hospital, Jakarta, Indonesia. 18. Department of Hepatology, Global Hospital, Mumbai, India. 19. Department of Hepatogastroenterology, Ziauddin University, Karachi, Pakistan. 20. Department of Hepatology, Cardinal Santos Medical Centre, Manila, Philippines. 21. Asian Institute of Gastroenterology, Hyderabad, India. 22. Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt. 23. Liver Foundation Nepal Sitapaila Height, Kathmandu, Nepal. 24. Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey. 25. Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. 26. Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines. 27. Division of Hepatobiliary Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia. 28. Department of Gastroenterology, VGM Hospital, Coimbatore, India. 29. Department of Gastroenterology, Humanity and Health Medical Centre, Hong Kong, China. 30. Department of Hepatology, Sir Salimullah Medical College, Dhaka, Bangladesh. 31. Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India. 32. Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India. 33. Department of Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India. 34. Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com. 35. Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India. shivsarin@gmail.com.
Abstract
BACKGROUND AND AIMS: Acute-on-chronic liver failure (ACLF) is a rapidly progressive illness with high short-term mortality. Timely liver transplant (LT) may improve survival. We evaluated various indices for assessment of the severity of liver failure and their application for eligibility and timing of living donor LT (LDLT). METHODS: Altogether 1021 patients were analyzed for the severity and organ failure at admission to determine transplant eligibility and 28 day survival with or without transplant. RESULTS: The ACLF cohort [mean age 44 ± 12.2 years, males 81%) was of sick patients; 55% willing for LT at admission, though 63% of them were ineligible due to sepsis or organ failure. On day 4, recovery in sepsis and/or organ failure led to an improvement in transplant eligibility from 37% at baseline to 63.7%. Delay in LT up to 7 days led to a higher incidence of multiorgan failure (p < 0.01) contributing to 23% of the first week and 55% of all-cause 28-day mortality. In a matched cohort analysis, the actuarial survival with LT (n = 41) and conditional survival in the absence of transplant (n = 191) were comparable, when the condition, i.e., transplant was adjusted. The comparison curve showed differentiation in survival beyond 7 days (p < 0.01). CONCLUSIONS: ACLF is a rapidly progressive disease and risk stratification within the first week of hospitalization is needed. 'Emergent LT' should be defined in the first week in the ACLF patients; the transplant window for improving survival in a live donor setting.
BACKGROUND AND AIMS: Acute-on-chronic liver failure (ACLF) is a rapidly progressive illness with high short-term mortality. Timely liver transplant (LT) may improve survival. We evaluated various indices for assessment of the severity of liver failure and their application for eligibility and timing of living donor LT (LDLT). METHODS: Altogether 1021 patients were analyzed for the severity and organ failure at admission to determine transplant eligibility and 28 day survival with or without transplant. RESULTS: The ACLF cohort [mean age 44 ± 12.2 years, males 81%) was of sick patients; 55% willing for LT at admission, though 63% of them were ineligible due to sepsis or organ failure. On day 4, recovery in sepsis and/or organ failure led to an improvement in transplant eligibility from 37% at baseline to 63.7%. Delay in LT up to 7 days led to a higher incidence of multiorgan failure (p < 0.01) contributing to 23% of the first week and 55% of all-cause 28-day mortality. In a matched cohort analysis, the actuarial survival with LT (n = 41) and conditional survival in the absence of transplant (n = 191) were comparable, when the condition, i.e., transplant was adjusted. The comparison curve showed differentiation in survival beyond 7 days (p < 0.01). CONCLUSIONS: ACLF is a rapidly progressive disease and risk stratification within the first week of hospitalization is needed. 'Emergent LT' should be defined in the first week in the ACLF patients; the transplant window for improving survival in a live donor setting.
Authors: Douglas A Simonetto; Laura Piccolo Serafim; Alice Gallo de Moraes; Ognjen Gajic; Patrick S Kamath Journal: Hepatology Date: 2019-07 Impact factor: 17.425
Authors: Ivan E Saraiva; Victor M Ortiz-Soriano; Xiaonan Mei; Fabiola G Gianella; Winnie Sheu Woc; Rodrigo Zamudio; Andrew Kelly; Meera Gupta; Alla Y Grigorian; Javier A Neyra Journal: Clin Nephrol Date: 2020-02-26 Impact factor: 0.975