Division of Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Transplantation. 2011 Oct 27;92(8):952-7. doi: 10.1097/TP.0b013e31822e6eda.
Acute decompensation in patients with chronic liver disease, resulting from acute kidney injury and infections, leads to significant morbidity and mortality. It is unclear whether patients who develop acute-on-chronic liver failure (ACLF) have poor outcomes after liver transplantation.
We performed a single-center retrospective cohort study of 332 patients to evaluate the effect of ACLF, defined as an acute rise in the Model for End-Stage Liver Disease score of more than 5 within 4 weeks before transplantation, on posttransplant outcomes including stage 4 chronic kidney disease, death, recurrent cirrhosis, or graft failure requiring retransplantation.
One hundred fifty-seven patients in the study had ACLF and 175 patients had no ACLF (non-ACLF) pretransplant. Thirty-four patients in the entire cohort received dual organs, 10 of them (29.4%) had ACLF. Seventy-six percent of the patients with ACLF had acute kidney injury as their reason for decompensation and 23.6% had an infection. Mean Model for End-Stage Liver Disease score at transplant was significantly different between the groups (ACLF 28.77 vs. non-ACLF 21.23, P<0.0001). A total of 16.6% of the patients achieved an estimated glomerular filtration rate (eGFR) less than 30 mL/min, 21% of patients died, 12.3% developed cirrhosis, and 7.5% received a second transplant. There was no difference in mean eGFR between the ACLF and non-ACLF cohorts at 3 years posttransplant (56.35 mL/min vs. 59.93 mL/min, respectively, P=0.27). On multivariate analysis, ACLF was not significantly associated with eGFR less than 30 mL/min, death, recurrent cirrhosis, or retransplantation when adjusted for potential confounders.
慢性肝病患者因急性肾损伤和感染导致的急性失代偿会导致较高的发病率和死亡率。目前尚不清楚发生慢加急性肝衰竭（ACLF）的患者在肝移植后是否预后较差。
我们进行了一项单中心回顾性队列研究，纳入了 332 例患者，旨在评估 ACLF（定义为移植前 4 周内终末期肝病模型评分升高超过 5 分）对移植后结局的影响，包括 4 期慢性肾脏病、死亡、复发性肝硬化或需要再次移植的移植物失功。
研究中 157 例患者存在 ACLF，175 例患者移植前无 ACLF（非 ACLF）。整个队列中有 34 例患者接受了双器官移植，其中 10 例（29.4%）存在 ACLF。ACLF 患者中 76%的急性失代偿原因为急性肾损伤，23.6%的患者存在感染。两组患者的终末期肝病模型评分在移植时存在显著差异（ACLF 28.77 分 vs. 非 ACLF 21.23 分，P<0.0001）。移植后共有 16.6%的患者估算肾小球滤过率（eGFR）<30 mL/min，21%的患者死亡，12.3%的患者发生肝硬化，7.5%的患者接受了再次移植。在移植后 3 年时，ACLF 组和非 ACLF 组的平均 eGFR 无显著差异（分别为 56.35 mL/min 和 59.93 mL/min，P=0.27）。多变量分析显示，在调整了潜在混杂因素后，ACLF 与 eGFR<30 mL/min、死亡、复发性肝硬化或再次移植无显著相关性。
