Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Hepatology. 2010 Mar;51(3):903-11. doi: 10.1002/hep.23369.
The outcomes of patients with acute liver failure (ALF) vary greatly according to etiology. Emergency adult-to-adult living-donor liver transplantation (adult LDLT) would help address the shortage of available organs for patients with ALF, especially in hepatitis B virus (HBV)-endemic areas. We analyzed a prospective database of 110 consecutive adult patients with ALF. ALF was defined as sudden development of severe coagulopathy and encephalopathy within 26 weeks of onset of symptoms. In about 90% of patients, ALF was caused by etiologies that usually result in poor outcomes, including HBV infection (37%). Three cases (3%) were associated with acetaminophen overdose. Of the 99 patients listed for emergency liver transplantation, four (4%) underwent deceased-donor liver transplantation (DDLT), and 40 (40%) underwent adult LDLT. The 1-year survival rate of adult LDLT patients was 85%. Of the 55 patients listed but not transplanted, 45 (82%) died within a median of 7 days (range, 1-90 days). Multivariate analysis showed that adult LDLT (hazard ratio [HR] 0.10, P < 0.01) and DDLT (HR 0.12, P = 0.04) were associated with decreased mortality, whereas older age (HR 1.03, P = 0.01) and higher Model for End-stage Liver Disease (MELD) (HR 1.03, P = 0.04) was associated with increased mortality of patients. There was no living donor mortality. Eight (17.8%) and three (6.7%) living donors experienced grade 1 and 2 complications, respectively.
Emergency adult LDLT can be performed expeditiously and safely for patients with ALF, and greatly improves the survival rate. As the window during which transplantation is possible is limited, emergency adult LDLT should be considered one of the first-line treatment options in patients with ALF, especially in regions in which ALFs are caused by etiologies associated with poor outcome and the supply of organs is severely limited.
急性肝衰竭（ALF）患者的预后因病因而异。紧急成人对成人活体肝移植（adult LDLT）有助于解决 ALF 患者可供器官短缺的问题，特别是在乙型肝炎病毒（HBV）流行地区。我们分析了 110 例连续成人 ALF 患者的前瞻性数据库。ALF 的定义为症状发作后 26 周内突然出现严重凝血功能障碍和脑病。在约 90%的患者中，ALF 是由通常导致预后不良的病因引起的，包括 HBV 感染（37%）。3 例（3%）与对乙酰氨基酚过量有关。在 99 例紧急肝移植患者中，4 例（4%）接受了尸体供肝移植（DDLT），40 例（40%）接受了成人 LDLT。成人 LDLT 患者的 1 年生存率为 85%。在未接受移植的 55 例患者中，45 例（82%）在中位时间 7 天（范围 1-90 天）内死亡。多因素分析显示，成人 LDLT（风险比[HR]0.10，P <0.01）和 DDLT（HR0.12，P=0.04）与死亡率降低相关，而年龄较大（HR1.03，P=0.01）和较高的终末期肝病模型（MELD）（HR1.03，P=0.04）与患者死亡率增加相关。没有活体供者死亡。8 例（17.8%）和 3 例（6.7%）活体供者分别发生 1 级和 2 级并发症。
紧急成人 LDLT 可快速、安全地用于 ALF 患者，大大提高了生存率。由于移植的窗口期有限，紧急成人 LDLT 应被视为 ALF 患者的一线治疗选择之一，特别是在 ALF 由预后不良的病因引起且器官供应严重受限的地区。
