Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Graduate School of Medicine, Kobe University, Kobe City, Hyogo, Japan.
Department of Internal Medicine, Division of Gastroenterology, Graduate School of Medicine, Kobe University, Kobe City, Hyogo, Japan.
Transplant Proc. 2021 Jun;53(5):1611-1615. doi: 10.1016/j.transproceed.2021.03.022. Epub 2021 May 6.
This study aims to validate Japanese diagnostic criteria for acute-on-chronic liver failure (ACLF) and confirm the feasibility of performing transplantation.
We included 60 patients with acute liver injury. Demographic and clinical features were retrospectively collected, and the primary outcome was compared among 4 types: acute liver failure (ALF) with hepatic coma (n = 23), ALF without hepatic coma (n = 12), acute liver injury (n = 20), and ACLF (n = 5). Moreover, 80 transplanted patients were enrolled to compare the difficulty of transplantation between ALF (n = 8) vs non-ALF (n = 72) patients.
Seven patients in the ALF with hepatic coma group and 1 patient in the ACLF with hepatic coma group were transplanted. Ten patients who could not be registered for transplantation died. In univariate analysis, liver failure type (P < .0001), total bilirubin level (P = .05), and prothrombin time internationalized ratio (P < .0001) were associated with patient survival. In multivariate analysis, liver failure type was associated with patient survival (P < .0001). The respective 1-, 3-, and 5-year patient survival rates were 45.9%, 45.9%, and 45.9% for ALF patients with hepatic coma; 100.0%, 100.0%, and 100.0% for ALF patients without hepatic coma and acute liver injury; and 80.0%, 80.0%, and 80.0% for ACLF patients (P < .0001). Chronic liver disease did not affect operation time (P = .46) and bleeding volume (P = .49).
Patients diagnosed with ACLF via Japanese criteria presented significantly higher survival rates than ALF patients with hepatic coma.
本研究旨在验证日本急性肝衰竭（ACLF）的诊断标准，并确认进行移植的可行性。
我们纳入了 60 例急性肝损伤患者。回顾性收集人口统计学和临床特征，主要结局比较了 4 种类型：肝性脑病（HE）的急性肝衰竭（ALF）（n=23）、无 HE 的 ALF（n=12）、急性肝损伤（n=20）和 ACLF（n=5）。此外，纳入了 80 例接受移植的患者，比较了 ALF（n=8）与非-ALF（n=72）患者移植的难度。
ALF 伴 HE 组的 7 例患者和 ACLF 伴 HE 组的 1 例患者接受了移植。10 例无法进行移植登记的患者死亡。单因素分析显示，肝功能衰竭类型（P<0.0001）、总胆红素水平（P=0.05）和凝血酶原时间国际标准化比值（P<0.0001）与患者生存相关。多因素分析显示，肝功能衰竭类型与患者生存相关（P<0.0001）。ALF 伴 HE 患者的 1、3 和 5 年生存率分别为 45.9%、45.9%和 45.9%；ALF 无 HE 和急性肝损伤患者分别为 100.0%、100.0%和 100.0%；ACLF 患者分别为 80.0%、80.0%和 80.0%（P<0.0001）。慢性肝病并不影响手术时间（P=0.46）和出血量（P=0.49）。
通过日本标准诊断的 ACLF 患者的生存率明显高于 ALF 伴 HE 患者。
