Singal, Ashwani K;
Yong-Fang, Kuo;
Waleed, Muhammad;
Wong, Robert J;
Sundaram, Vinay;
Jalan, Rajiv;
(2022)
High-risk liver transplant recipients with grade 3 acute on chronic liver failure should receive the good quality graft.
Liver International
, 42
(7)
pp. 1629-1637.
10.1111/liv.15263.
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Abstract
Background & Aim: We aimed to develop a risk score for LT recipients and donor selection among patients with ACLF-3. Methods and Results: A total of 7166 adult LT recipients (mean age 53 years, 63% males, 56% Caucasians, 42% obese, median MELD score 36.5) using deceased donor grafts in the UNOS database (01/2002–06/2018) who were in ACLF-3 at LT as per EASL-CLIF criteria were analysed. Cox regression model on the derivation dataset (N = 3583) showed recipient age, non-alcohol aetiology, pulmonary failure, brain failure and cardiovascular failure to be associated with 1-year patient survival. Observed and expected post-transplant 1-year survival showed excellent correlation (R =.920). Risk score from cox model on derivation dataset stratified 3583 recipients in validation cohort using cut-off scores 7.55 and 11.57 to low (N = 1211), medium (N = 1168) and high risk (N = 1199), with 1-year patient survival of 89%, 82% and 80% respectively. Based on poor versus good quality graft (donor risk index cut-off at 1.50), 1-year patient survival for low, medium and high-risk categories were 90 versus 89% (p =.490), 83 versus 82% (p =.390) and 83 versus 78% (p =.038) respectively. Among recipients with a high-risk score, donor factors of age ≥60 years, grafts obtained from national sharing and macro-steatosis >15% were associated with 1-year patient survival below 66%. Conclusion: Among ACLF-3 liver transplant recipients, those with high risk at the time of transplant receiving better quality graft will improve post-transplant outcomes. Prospective studies using additional characteristics are needed to derive an accurate risk score model in predicting post-transplant outcomes among recipients with ACLF-3.
| Type: | Article |
|---|---|
| Title: | High-risk liver transplant recipients with grade 3 acute on chronic liver failure should receive the good quality graft |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/liv.15263 |
| Publisher version: | https://doi.org/10.1111/liv.15263 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | ACLF, cirrhosis, mortality, organ failure, survival, UNOS, OUTCOMES, MORTALITY, DISEASE, SURVIVAL, IMPACT |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10150935 |
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