Published online Oct 28, 2022. doi: 10.3748/wjg.v28.i40.5881
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
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.
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.
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.
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.
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.
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.
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.