基于欧洲肝脏研究学会-慢性肝衰竭（EASL-CLIF）诊断标准的活体肝移植治疗慢加急性肝衰竭
Living Donor Liver Transplantation for Acute on Chronic Liver Failure Based on EASL-CLIF Diagnostic Criteria.
作者信息
Bhatti Abu Bakar H, Dar Faisal S, Butt Muhammad O, Sahaab Eraj, Salih Mohammad, Shah Najmul H, Khan Nusrat Y, Zia Haseeb H, Khan Eitzaz U, Khan Nasir A
机构信息
Department of HPB Surgery and Liver Transplantation, Shifa International Hospital, Sector H-8/4, Pitras Bukhari Road, Islamabad, Pakistan.
Department of Hepatology, Shifa International Hospital, Sector H-8/4, Pitras Bukhari Road, Islamabad, Pakistan.
出版信息
J Clin Exp Hepatol. 2018 Jun;8(2):136-143. doi: 10.1016/j.jceh.2017.11.007. Epub 2017 Nov 24.
BACKGROUND
The European association for the study of the liver and chronic liver failure consortium (EASL-CLIF) recently proposed diagnostic criteria for acute on chronic liver failure (ACLF). There is lack of data regarding liver transplant outcomes in ACLF patients based on these criteria. The objective of this study was to determine outcome following living donor liver transplantation (LDLT) in ACLF patients.
METHODS
We retrospectively reviewed patients who underwent LDLT for ACLF based on European association for the study of the liver and chronic liver failure consortium (EASL-CLIF) diagnostic criteria (group 1) ( = 60) and compared them with ACLF patients who did not undergo transplantation (group 2) ( = 59). The primary outcome of interest was 30 day mortality. We also looked at one year survival in these patients. Survival was calculated using Kaplan-Meier curves and Log rank test was used to determine significance between variables.
RESULTS
Median MELD scores for group 1 and 2 patients in ACLF grade 1 was 28 (20-38) and 31 (24-36), in ACLF grade 2 was 35 (24-42) and 36 (24-42) and in ACLF grade 3 was 36 (29-42) and 38 (32-52). For group 1 and 2, 30 day mortality in ACLF grade 1, 2 and 3 was 2/43(4.6%) versus 9/15(60%) ( < 0.001), 1/15 (6.6%) versus 13/19 (68.4%), 0/2 (0%) versus 20/25 (80%) ( < 0.001). Actuarial 1 year overall survival was 92% versus 11% ( < 0.001) in patients who underwent transplantation versus those who did not. One year survival in patients with grade 1 and 2 ACLF who received transplant versus medical treatment was 91% versus 13% and 93% versus 15% ( < 0.001) respectively.
CONCLUSION
LDLT has excellent outcomes in patients with EASL-CLIF grade 1 and 2 ACLF. Without transplantation, ACLF patients have a very poor prognosis.
背景
欧洲肝脏研究协会和慢性肝衰竭联盟（EASL-CLIF）最近提出了急性慢性肝衰竭（ACLF）的诊断标准。基于这些标准，关于ACLF患者肝移植结局的数据尚缺乏。本研究的目的是确定ACLF患者活体肝移植（LDLT）后的结局。
方法
我们回顾性分析了根据欧洲肝脏研究协会和慢性肝衰竭联盟（EASL-CLIF）诊断标准接受LDLT治疗ACLF的患者（第1组）（n = 60），并将其与未接受移植的ACLF患者（第2组）（n = 59）进行比较。主要关注的结局是30天死亡率。我们还观察了这些患者的1年生存率。使用Kaplan-Meier曲线计算生存率，并使用Log rank检验确定变量之间的显著性。
结果
ACLF 1级的第1组和第2组患者的中位MELD评分分别为28（20 - 38）和31（24 - 36），ACLF 2级为35（24 - 42）和36（24 - 42），ACLF 3级为36（29 - 42）和38（32 - 52）。对于第1组和第2组，ACLF 1级、2级和3级的30天死亡率分别为2/43（4.6%）对9/15（60%）（P < 0.001），1/15（6.6%）对13/19（68.4%），0/2（0%）对20/25（80%）（P < 0.001）。接受移植与未接受移植患者的1年总生存率分别为92%对11%（P < 0.001）。ACLF 1级和2级接受移植与接受药物治疗患者的1年生存率分别为91%对13%和93%对15%（P < 0.001）。
结论
LDLT治疗EASL-CLIF 1级和2级ACLF患者的结局良好。未经移植，ACLF患者的预后非常差。
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