系统评价和荟萃分析：肝移植为慢加急性肝衰竭患者提供生存获益。
Systematic review with meta-analysis: liver transplant provides survival benefit in patients with acute on chronic liver failure.
机构信息
Department of Medicine, University of SD Sanford School of Medicine, Sioux Falls, SD, USA.
Division of Gastroenterology and Hepatology, Alameda Health System Highland Hospital, Oakland, CA, USA.
出版信息
Aliment Pharmacol Ther. 2020 Jul;52(2):222-232. doi: 10.1111/apt.15793. Epub 2020 Jun 3.
BACKGROUND
Data on liver transplantation (LT) in acute on chronic liver failure (ACLF) are scanty.
AIM
To perform meta-analysis on outcomes after LT for ACLF compared with ACLF patients not receiving LT or with LT recipients for indications other than ACLF.
METHODS
We pooled data from 12 studies on LT outcomes among ACLF patients.
RESULTS
Among nine studies, 22 238 LT recipients for ACLF vs 30 791 for non-ACLF were younger by 1.1 years, less males (64% vs 66.4%), and higher model for end-stage disease score by 14.5 (14.4-14.6), P < 0.01 for all. Post-transplant patient survival at 30 day, 90 day, 6 months, 1 year and 5 years was lower in ACLF: 96.2% vs 98.1%, 92.6% vs 96.2%, 89.9% vs 94.4%, 86.0% vs 91.9%, 66.9% vs 80.7% respectively, P < 0.01 for all. ACLF patients stayed longer in hospital and ICU by 5.7 and 10.5 days respectively, P < 0.001, with similar post-transplant complications [74.4% vs 55.5%, P = 0.12]. Among three studies, 441 LT recipients for ACLF vs 301 ACLF patients not selected for LT had better 30 day and 1 year survival: 95.2% vs 60% and 85.3% vs 28.2% respectively, P < 0.001. Outcomes were worse in ACLF-3 and better for ACLF-1 and ACLF-2 patients at the time of LT.
CONCLUSION
In this pooled analysis with a large sample size across the globe, LT for select patients with ACLF provided survival benefit. However, larger prospective studies are needed to further refine selection criteria, especially for ACLF-3 patients as basis for improving outcomes and optimal utilisation of scarce donor pool.
背景
关于急性慢性肝衰竭（ACLF）患者肝移植（LT）的数据很少。
目的
对 LT 治疗 ACLF 患者与未接受 LT 治疗或因非 ACLF 原因接受 LT 治疗的 ACLF 患者的结局进行荟萃分析。
方法
我们对 12 项关于 ACLF 患者 LT 结局的研究进行了数据汇总。
结果
在 9 项研究中，22238 例 LT 治疗 ACLF 患者比 30791 例非 ACLF 患者年轻 1.1 岁，男性比例（64%对 66.4%）更低，终末期肝病模型评分高 14.5（14.4-14.6），所有 P 值均＜0.01。ACLF 患者的移植后 30 天、90 天、6 个月、1 年和 5 年的患者生存率较低：96.2%对 98.1%，92.6%对 96.2%，89.9%对 94.4%，86.0%对 91.9%，66.9%对 80.7%，所有 P 值均＜0.01。ACLF 患者的住院时间和 ICU 入住时间分别延长 5.7 天和 10.5 天，均 P＜0.001，移植后并发症相似[74.4%对 55.5%，P=0.12]。在 3 项研究中，441 例 LT 治疗 ACLF 患者比 301 例未选择 LT 治疗的 ACLF 患者的 30 天和 1 年生存率更好：95.2%对 60%和 85.3%对 28.2%，均 P＜0.001。在 LT 时，ACLF-3 患者的结局较差，ACLF-1 和 ACLF-2 患者的结局较好。
结论
在这项全球性的大型样本量荟萃分析中，LT 治疗有选择的 ACLF 患者可带来生存获益。然而，需要进行更大规模的前瞻性研究来进一步细化选择标准，特别是对于 ACLF-3 患者，以改善结局和最佳利用稀缺的供体库。
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