Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2022; 28(40): 5881-5892
Published online Oct 28, 2022. doi: 10.3748/wjg.v28.i40.5881
Liver transplantation is beneficial regardless of cirrhosis stage or acute-on-chronic liver failure grade: A single-center experience
Eduardo Cervantes-Alvarez, Mario Vilatoba, Nathaly Limon-de la Rosa, Osvely Mendez-Guerrero, David Kershenobich, Aldo Torre, Nalu Navarro-Alvarez
Eduardo Cervantes-Alvarez, PECEM, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 14080, Mexico
Eduardo Cervantes-Alvarez, Nathaly Limon-de la Rosa, Osvely Mendez-Guerrero, David Kershenobich, Aldo Torre, Nalu Navarro-Alvarez, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
Mario Vilatoba, Department of Trasplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
Nalu Navarro-Alvarez, Department of Molecular Biology, Universidad Panamericana School of Medicine, Mexico City 03920, Mexico
Nalu Navarro-Alvarez, Department of Surgery, University of Colorado Anschutz Medical Campus, Denver, CO 80045, United States
Author contributions: Cervantes-Alvarez E and Navarro-Alvarez N envisioned the study and wrote the manuscript; Cervantes-Alvarez E, Limon-de la Rosa N and Mendez-Guerrero O supported the data collection and made the formal analysis; Navarro-Alvarez N, Kershenobich D, Vilatoba M, Torre A, Limon-de la Rosa N, Mendez-Guerrero O and Cervantes-Alvarez E reviewed and edited the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Research Ethics Committee of Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (GAS-2368-17-20).
Informed consent statement: Requirement of informed consent was waived due to the observational nature of this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nalu Navarro-Alvarez, MD, PhD, Assistant Professor, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Mexico City 14080, Mexico. nalu.navarroa@incmnsz.mx
Received: April 25, 2022
Peer-review started: April 25, 2022
First decision: May 30, 2022
Revised: June 21, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: October 28, 2022
Research background

Currently, liver transplantation (LT) is the only definitive therapeutic measure for patients with cirrhosis, albeit with the implied risks including posttransplant complications and the long-term use of immunosuppressive drugs. However, these patients benefit in general from excellent posttransplant survival. The benefit and survival of this procedure for patients with more advanced cirrhosis such as those with acute-on-chronic liver failure (ACLF), still remains controversial, with some reports showing a clear benefit, while others reporting lower short and long-term survival after transplant.

Research motivation

In order to contribute to the current literature regarding the benefit of LT even in those with more severe diseases, we evaluate the immediate posttransplant outcomes and compared the posttransplant survival in patients stratified by disease severity.

Research objectives

To assess immediate posttransplant outcomes and compare the short (1 year) and long-term (6 years) posttransplant survival among cirrhotic patients stratified by disease severity.

Research methods

We included cirrhotic patients undergoing liver transplantation between 2015 and 2019 and categorized them into compensated cirrhosis (CC), decompensated cirrhosis (DC), and ACLF. ACLF was further divided into severity grades. Medical records of all patients were examined to extract demographic and clinical variables as well as laboratory data measured at the time of LT and in the posttransplant period. Our primary outcomes of interest were: the development of immediate posttransplant infectious complications, defined as any type of nosocomial-acquired, donor-derived or surgery-related infection presented during the immediate hospital stay following LT until the patients’ discharge; the development of any type of immediate postoperative complication according to Clavien-Dindo classification; and post-LT survival at 1 year and 6 years. Posttransplant survival was analyzed with the Kaplan-Meier method and survival curves were compared with the log-rank test.

Research results

A total of 235 patients underwent liver transplantation (CC = 11, DC = 129 and ACLF = 95). Patients with ACLF had a significantly longer hospital stay and developed more infection-related complications. Posttransplant survival at 1- and 6-years was similar among groups. When ACLF patients were stratified according to ACLF grade, similar intensive care unit and hospital stay lengths were found, as well as comparable frequencies of overall and infectious posttransplant complications. Despite that, there was no survival difference between ACLF grades at 1 year and 6 years.

Research conclusions

Patients may benefit from liver transplantation regardless of the cirrhosis stage. Despite having a longer hospital stay and a higher frequency of infectious complications, ACLF patients have excellent and comparable 1 and 6-year survival rates.

Research perspectives

A multicenter study would be required to determine the value of LT in advanced disease patients such as those with ACLF according to disease etiology.