Agbim Uchenna, Sharma Anuj, Maliakkal Benedict, Karri Saradasri, Yazawa Masahiko, Goldkamp William, Podila Pradeep S B, Vanatta Jason M, Gonzalez Humberto, Molnar Miklos Z, Nair Satheesh P, Eason James D, Satapathy Sanjaya K
Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN.
Transplant Direct. 2020 Mar 18;6(4):e544. doi: 10.1097/TXD.0000000000000984. eCollection 2020 Apr.
The impact of acute-on-chronic liver failure (ACLF) defined by European Association for the Study of the Liver-Chronic Liver Failure in liver transplant (LT) recipients has not been well characterized. The aim of the study was to assess early posttransplant morbidity and survival of ACLF patients.
Eight hundred twenty-five consecutive LT patients (04/2006-03/2013) were included in a retrospective analysis. Of the 690 evaluable patients, 589 had no ACLF, and the remaining 101 were grouped into ACLF Grades 1-3 (ACLF Grade 1: 50 [49.5%], ACLF Grade 2: 32 [31.7%], and ACLF Grade 3: 19 [18.8%]).
LT recipients transplanted in the context of ACLF had significantly increased serum creatinine (2.27 ± 1.16 versus 0.98 ± 0.32; < 0.0001), and inferior 1-year graft (90% versus 78%; < 0.0001) and patient survival (92% versus 82%; = 0.0004) by Kaplan-Meier survival analysis; graft and patient survival correlated negatively with increasing severity of ACLF. One-year graft and patient survival were lower in those with high ACLF (Grade 2 and 3) irrespective of Model for End-Stage Liver Disease compared with other groups. The ACLF group had longer intensive care unit stays (10.6 ± 19.5 versus 4.2 ± 9; < 0.0001), hospital stays (20.9 ± 25.9 versus 11.7 ± 11.4; < 0.0001), and increased surgical re-exploration (26.7 % versus 14.6%, = 0.002).
Patients with ACLF undergoing LT have significantly higher resource utilization, inferior graft survival and patient survival, and renal dysfunction at 1 year. The combination of ACLF and Model for End-Stage Liver Disease can be considered when determining the suitability for potential transplantation.
欧洲肝脏研究协会定义的慢性肝衰竭基础上的急性肝衰竭（ACLF）对肝移植（LT）受者的影响尚未得到充分描述。本研究的目的是评估ACLF患者肝移植后的早期发病率和生存率。
对825例连续的LT患者（2006年4月至2013年3月）进行回顾性分析。在690例可评估患者中，589例无ACLF，其余101例分为ACLF 1 - 3级（ACLF 1级：50例[49.5%]，ACLF 2级：32例[31.7%]，ACLF 3级：19例[18.8%]）。
通过Kaplan - Meier生存分析，在ACLF背景下接受移植的LT受者血清肌酐显著升高（2.27±1.16对0.98±0.32；<0.0001），1年移植物存活率（90%对78%；<0.0001）和患者生存率（92%对82%；=0.0004）较低；移植物和患者生存率与ACLF严重程度增加呈负相关。与其他组相比，无论终末期肝病模型如何，高ACLF（2级和3级）患者的1年移植物和患者生存率较低。ACLF组的重症监护病房住院时间更长（10.6±19.5对4.2±9；<0.0001），住院时间更长（20.9±25.9对11.7±11.4；<0.0001），手术再次探查率增加（26.7%对14.6%，=0.002）。
接受LT的ACLF患者资源利用率显著更高，1年时移植物存活率和患者生存率较低，且存在肾功能障碍。在确定潜在移植的适用性时，可考虑ACLF和终末期肝病模型的联合情况。
