Benítez Carlos, Arnold Jorge, Cambindo Verónica, Schoenfeldt Fernanda, Cancino Alejandra, Ibáñez Samuel, Grandy Catalina, Hunfan Paola, González Jorge, Guerra Catalina, Godoy Esteban, Araneda Verónica, Mollo Constanza, Poniachik Jaime, Urzúa Alvaro, Cattaneo Máximo, Roblero Juan Pablo, Oppenheimer Ilan, Pizarro Vicente
Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile.
Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile.
Ann Hepatol. 2023 Sep-Oct;28(5):101128. doi: 10.1016/j.aohep.2023.101128. Epub 2023 Jun 17.
Acute-on-chronic liver failure (ACLF) is associated with reduced short-term survival, and liver transplantation is frequently the only therapeutic option. Nonetheless, the post-transplantation prognosis seems to be worse in ACLF patients.
The databases of two university centers were retrospectively evaluated, and adult patients with cirrhosis who underwent transplantation between 2013 and 2020 were included. One-year survival of patients with ACLF was compared to that of patients without ACLF. Variables associated with mortality were identified.
A total of 428 patients were evaluated, and 303 met the inclusion criteria; 57.1% were male, the mean age was 57.1 ± 10.2 years, 75 patients had ACLF, and 228 did not. The main etiologies of ACLF were NASH (36.6%), alcoholic liver disease (13.9%), primary biliary cholangitis (8.6%) and autoimmune hepatitis (7.9%). Mechanical ventilation, renal replacement therapy, the use of vasopressors and the requirement of blood product transfusion during liver transplantation were significantly more frequent in ACLF patients. Among those recipients without and with ACLF, survival at 1, 3 and 5 years was 91.2% vs. 74.7%, 89.1% vs. 72.6% and 88.3% vs. 72.6%, respectively (p=0.001). Among pre-transplantation variables, only the presence of ACLF was independently associated with survival (HR 3.2, 95% CI: 1.46-7.11). Post-transplantation variables independently associated with survival were renal replacement therapy (HR 2.8, 95% CI: 1.1-6.8) and fungal infections (HR 3.26, 95% CI: 1.07-9.9).
ACLF is an independent predictor of one-year post-transplantation survival. Importantly, transplant recipients with ACLF require the use of more resources than patients without ACLF.
急性慢性肝功能衰竭（ACLF）与短期生存率降低相关，肝移植常常是唯一的治疗选择。尽管如此，ACLF患者移植后的预后似乎更差。
对两个大学中心的数据库进行回顾性评估，纳入2013年至2020年间接受移植的成年肝硬化患者。比较ACLF患者与非ACLF患者的一年生存率。确定与死亡率相关的变量。
共评估428例患者，303例符合纳入标准；57.1%为男性，平均年龄为57.1±10.2岁，75例患有ACLF，228例未患ACLF。ACLF的主要病因是非酒精性脂肪性肝炎（NASH，36.6%）、酒精性肝病（13.9%）、原发性胆汁性胆管炎（8.6%）和自身免疫性肝炎（7.9%）。ACLF患者在肝移植期间机械通气、肾脏替代治疗、血管升压药的使用以及血液制品输血需求明显更频繁。在无ACLF和有ACLF的受者中，1年、3年和5年生存率分别为91.2%对74.7%、89.1%对72.6%和88.3%对72.6%（p=0.001）。在移植前变量中，只有ACLF的存在与生存率独立相关（HR 3.2，95%CI：1.46 - 7.11）。与生存率独立相关的移植后变量是肾脏替代治疗（HR 2.8，95%CI：1.1 - 6.8）和真菌感染（HR 3.26，95%CI：
