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Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database.

Germani, G; Theocharidou, E; Adam, R; Karam, V; Wendon, J; O'Grady, J; Burra, P; (2012) Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. J Hepatol , 57 (2) pp. 288-296. 10.1016/j.jhep.2012.03.017.

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Abstract

BACKGROUND & AIMS: Liver transplantation for acute liver failure (ALF) still has a high early mortality. We evaluated changes during 20 years, and identified risk factors for poor outcome. METHODS: Donor, graft, and recipient variables from the European Liver Transplant Registry database (January 1988-June 2009), were analysed. Aetiologies and time periods were compared. Three and 12-month survival models were generated from separate training data sets, which were validated. A sub-analysis was performed for recipient older than 50 years. RESULTS: Four thousand nine hundred and three patients were evaluated. One, 5- and 10-year patient, and graft survival rates were 74%, 68%, 63%, and 63%, 57%, 50%, respectively. Survival was better in 2004-2009 compared to previous quinquennia (p<0.001), despite donors >60 years increased from 1.8% to 21%. A higher incidence of suicide or non-adherence occurred in paracetamol-related ALF (p<0.001). Death or graft loss were independently associated with male recipients (adjusted OR 1.25), recipient >50 years (1.26), incompatible ABO matching (1.93), donors >60 years (1.21), and reduced size graft (1.54). For both 3- and 12-month models, incompatible ABO matching, non-viral aetiology, reduced size graft, and non-UW preservation fluid were associated with increased mortality/graft loss, whereas male recipients and age >50 years were associated only at 12 months. Both models had reasonable discriminative ability with good calibration at 3 months. Recipients >50 years, combined with donors >60 years resulted in 57% mortality/graft loss within the first year. CONCLUSIONS: Survival after liver transplantation has improved despite increases in donor/recipient age. Recipients >50 years paired with donors >60 years had a very high mortality/graft loss within the first year.

Type: Article
Title: Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database.
Location: England
DOI: 10.1016/j.jhep.2012.03.017
Keywords: Adult, Databases, Factual, Europe, Female, Humans, Liver Failure, Acute, Liver Transplantation, Male, Middle Aged, Proportional Hazards Models, Time Factors, Tissue Donors, Treatment Outcome
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Medicine (Division of)
URI: http://discovery.ucl.ac.uk/id/eprint/1369540
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