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©The Author(s) 2022.
World J Gastroenterol. Oct 28, 2022; 28(40): 5881-5892
Published online Oct 28, 2022. doi: 10.3748/wjg.v28.i40.5881
Published online Oct 28, 2022. doi: 10.3748/wjg.v28.i40.5881
Table 1 Patient characteristics (n = 235)
CC, n = 11 (4.5%) | DC, n= 129 (52.9%) | ACLF, n = 95 (38.9%) | P value | |
Male gender, n (%) | 6 (54.5) | 64 (49.6) | 47 (49.5) | 0.95 |
Age, yr | 57.0 (53.0-59.0)a | 52.0 (43.0-61.0)c | 50.0 (37.0-59.0)a,c | 0.02 |
Liver cirrhosis etiology, n (%) | ||||
Autoimmune | 1 (9.1)a | 36 (27.9)c | 42 (44.2)a,c | < 0.01 |
HCV | 8 (72.7)a,b | 42 (32.6)b,c | 13 (13.7)a,c | < 0.0001 |
Alcoholic liver disease | 1 (9.1) | 11 (8.5) | 9 (9.5) | 0.93 |
NASH | 0 (0.0) | 7 (5.4) | 6 (6.3) | 0.88 |
Cryptogenic | 1 (9.1) | 22 (17.1) | 18 (18.9) | 0.76 |
Other1 | 0 (0.0) | 11 (8.5) | 7 (7.4) | 0.84 |
Comorbidities, n (%) | ||||
Type 2 diabetes mellitus | 3 (27.3) | 22 (17.1) | 13 (13.7) | 0.44 |
Primary hypertension | 2 (18.2) | 20 (15.5) | 6 (6.3) | 0.06 |
Pre-transplant clinical data | ||||
MELD-Na | 11 ± 3a,b | 19 ± 4b,c | 25 ± 6a,c | < 0.0001 |
Total bilirubin (mg/dL) | 1.18 (1.03-1.45)a,b | 3.39 (2.3-5.46)b,c | 7.70 (4.14-16.63)a,c | < 0.0001 |
INR | 1.1 (1.1-1.2)a,b | 1.5 (1.3-1.7)b | 1.5 (1.3-2.0)a | < 0.0001 |
Serum creatinine (mg/dL) | 0.67 (0.57-0.71)a | 0.73 (0.61-0.88)c | 0.97 (0.75-1.35)a,c | < 0.0001 |
Leukocyte count (× 109/L) | 2.9 (2.4-3)a | 4 (3.1-5)c | 5.4 (3.8-6.8)a,c | < 0.0001 |
Disease manifestations2, n (%) | ||||
Clinical ascites | 0 (0.0)a,b | 88 (68.2)b,c | 88 (92.6)a,c | < 0.0001 |
Encephalopathy | 0 (0.0)a,b | 69 (53.5)b,c | 80 (84.2)a,c | < 0.0001 |
Grade 3-4 encephalopathy (West- Haven) | 0 (0.0)a,b | 7 (5.4)b,c | 37 (38.9)a,c | < 0.0001 |
Table 2 Acute-on-chronic liver failure patients characteristics (n = 95)
ACLF-1,n = 40 (42.1%) | ACLF-2, n = 33 (34.7%) | ACLF-3, n = 22 (23.2%) | P value | |
Male gender, n (%) | 21 (52.5) | 17 (51.5) | 11 (50.0) | 0.98 |
Age, yr | 55.0 (39.8-60.0) | 44.0 (36.5-53.0) | 49.0 (37.5-59.3) | 0.14 |
Time to LT since ACLF event | 54.0 (21.3-122.8)a,b | 31.0 (7.0-59.5)b | 22.0 (9.5-46.8)a | 0.03 |
Liver cirrhosis etiology, n (%) | ||||
Autoimmune | 14 (35.0) | 17 (51.5) | 11 (50.0) | 0.30 |
HCV | 9 (22.5) | 2 (6.1) | 2 (9.1) | 0.14 |
Alcoholic liver disease | 2 (5.0) | 4 (12.1) | 3 (13.6) | 0.44 |
NASH | 3 (7.5) | 2 (6.1) | 1 (4.5) | 0.99 |
Cryptogenic | 10 (25.0) | 5 (15.2) | 3 (13.6) | 0.50 |
Other1 | 2 (5.0) | 3 (9.1) | 2 (9.1) | 0.69 |
ACLF precipitant, n (%) | ||||
Bacterial infection | 14 (35.0) | 16 (48.5) | 11 (50.0) | 0.39 |
Gastrointestinal hemorrhage | 1 (2.5) | 3 (9.1) | 1 (4.5) | 0.44 |
Active alcoholism | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0.99 |
Other | 10 (25.0)a | 2 (6.1) | 0 (0.0)a | 0.01 |
Unknown | 15 (37.5) | 12 (36.4) | 10 (45.5) | 0.77 |
Organ failures, n (%) | ||||
Liver | 14 (35.0)a,b | 22 (66.7)b | 16 (72.7)a | < 0.01 |
Kidney | 18 (45.0) | 11 (33.3) | 14 (63.6) | 0.09 |
Brain | 5 (12.5)a | 10 (30.3) | 11 (50.0)a | < 0.01 |
Coagulation | 3 (7.5)a,b | 12 (36.4)b | 11 (50.0)a | < 0.001 |
Circulation | 0 (0.0)a,b | 8 (24.2)b,c | 14 (63.6)a,c | < 0.0001 |
Lung | 1 (2.5)a | 3 (9.1) | 7 (31.8)a | < 0.01 |
ACLF event clinical data | ||||
MELD-Na | 27 ± 4a,b | 29 ± 5b,c | 35 ± 4a,c | < 0.0001 |
CLIF-C OF | 9 ± 1a,b | 10 ± 1b,c | 12 ± 2a,c | < 0.0001 |
CLIF-C ACLF | 39 ± 8a | 43 ± 6c | 52 ± 6a,c | < 0.0001 |
Total bilirubin (mg/dL) | 6.31 (2.99-12.91)a,b | 13.07 (6.39-22.31)b | 23.08 (10.56-27.76)a | < 0.001 |
INR | 1.5 (1.2-1.9)a,b | 1.9 (1.4-2.5)b | 2.2 (1.7-2.8)a | < 0.001 |
Serum creatinine (mg/dL) | 1.86 (1.18-2.27)b | 0.93 (0.71-1.99)b,c | 2.25 (1.42-2.87)c | < 0.01 |
Leukocyte count (× 109/L) | 6.55 (4.73-9.43)a | 6.60 (4.55-8.25)c | 8.75 (6.88-13.05)a,c | < 0.01 |
Pre-transplant clinical data | ||||
MELD-Na | 23 ± 4a | 25 ± 5c | 29 ± 8a,c | < 0.0001 |
CLIF-C OF | 8 ± 2a | 9 ± 2 | 10 ± 2a | 0.01 |
CLIF-C ACLF | 37 ± 9 | 37 ± 8 | 41 ± 12 | 0.18 |
Total bilirubin (mg/dL) | 4.58 (2.94-8.60)a | 9.75 (5.40-16.62) | 19.59 (5.48-34.11)a | < 0.01 |
INR | 1.4 (1.3-1.7) | 1.6 (1.3-2.2) | 1.9 (1.4-2.6) | 0.05 |
Serum creatinine (mg/dL) | 0.96 (0.75-1.29)a | 0.88 (0.72-1.17)c | 1.23 (0.94-1.95)a,c | < 0.01 |
Leukocyte count (× 109/L) | 4.40 (3.23-6.70) | 4.80 (2.90-6.30) | 4.75 (2.48-10.45) | 0.92 |
Table 3 Posttransplant outcomes (n = 235)
CC, n = 11 (4.5%) | DC, n = 129 (52.9%) | ACLF, n = 95 (38.9%) | P value | |
ICU stay (d) | 2.0 (1.0-4.0) | 2.0 (1.5-4.0) | 3.0 (2.0-5.0) | 0.05 |
Hospital stay (d) | 6.0 (3.0-7.0)a | 7.0 (4.5-10.0) | 8.0 (6.0-13.0)a | 0.01 |
Any type of complication, n (%) | 7 (63.6) | 105 (81.4) | 85 (89.5) | 0.05 |
Infectious complications, n (%) | 1 (9.1)a | 38 (29.5)b | 47 (49.5)a,b | < 0.01 |
Complications (Clavien-Dindo), n (%) | ||||
I | 4 (36.4) | 17 (13.2) | 19 (20.0) | 0.08 |
II | 2 (18.2) | 51 (39.5) | 32 (33.7) | 0.31 |
III | 1 (9.1) | 14 (10.9) | 17 (17.9) | 0.27 |
IV | 0 (0.0) | 9 (7.0) | 12 (12.6) | 0.23 |
V | 0 (0.0) | 14 (10.9) | 5 (5.3) | 0.24 |
Table 4 Acute-on-chronic liver failure posttransplant outcomes (n = 95)
ACLF-1, n = 40 (42.1%) | ACLF-2, n = 33 (34.7%) | ACLF-3, n = 22 (23.2%) | P value | |
ICU stay (d) | 3.0 (2.0-4.0) | 3.0 (2.0-6.0) | 3.0 (2.0-6.0) | 0.68 |
Hospital stay (d) | 8.0 (5.0-11.8) | 8.0 (6.0-15.5) | 6.0 (5.8-14.3) | 0.54 |
Any type of complication, n (%) | 35 (87.5) | 31 (93.9) | 19 (86.4) | 0.58 |
Infectious complications, n (%) | 20 (50.0) | 15 (45.5) | 12 (54.5) | 0.80 |
Complications (Clavien-Dindo), n (%) | ||||
I | 7 (17.5) | 6 (18.2) | 6 (27.3) | 0.62 |
II | 17 (42.5) | 11 (33.3) | 4 (18.2) | 0.15 |
III | 5 (12.5) | 7 (21.2) | 5 (22.7) | 0.50 |
IV | 4 (10.0) | 6 (18.2) | 2 (9.1) | 0.49 |
V | 2 (5.0) | 1 (3.0) | 2 (9.1) | 0.61 |
Table 5 Posttransplant survival overall and by acute-on-chronic liver failure grade, n (%)
CC, n = 11 (4.5%) | DC, n = 129 (52.9%) | ACLF, n = 95 (38.9%) | P value | ACLF-1, n = 40 (42.1%) | ACLF-2, n = 33 (34.7%) | ACLF-3, n = 22 (23.2%) | P value | |
DRI | 1.41 (1.36-2.26) | 1.38 (1.21-1.53) | 1.32 (1.19-1.54) | 0.13 | 1.43 (1.24-1.62) | 1.27 (1.20-1.43) | 1.38 (1.20-1.69) | 0.08 |
30-d mortality | 0 (0.0) | 10 (7.8) | 3 (3.2) | 0.38 | 1 (2.5) | 0 (0.0) | 2 (9.1) | 0.17 |
3-mo mortality | 0 (0.0) | 15 (11.6) | 6 (6.3) | 0.30 | 3 (7.5) | 1 (3.0) | 2 (9.1) | 0.65 |
1-yr survival | 11 (100) | 114 (88.4) | 87 (91.6) | 0.60 | 35 (87.5) | 32 (97.0) | 20 (90.9) | 0.40 |
Overall survival1 | 10 (90.9) | 112 (86.8) | 80 (84.2) | 0.90 | 32 (80.0) | 31 (93.9) | 17 (77.3) | 0.15 |
- Citation: Cervantes-Alvarez E, Vilatoba M, Limon-de la Rosa N, Mendez-Guerrero O, Kershenobich D, Torre A, Navarro-Alvarez N. Liver transplantation is beneficial regardless of cirrhosis stage or acute-on-chronic liver failure grade: A single-center experience. World J Gastroenterol 2022; 28(40): 5881-5892
- URL: https://www.wjgnet.com/1007-9327/full/v28/i40/5881.htm
- DOI: https://dx.doi.org/10.3748/wjg.v28.i40.5881