Department of Anaesthesiology and Critical Care, Center for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, 110017, India.
Department of Anaesthesiology and Critical Care, Center for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, 110017, India.
Dig Liver Dis. 2024 Jan;56(1):152-158. doi: 10.1016/j.dld.2023.07.024. Epub 2023 Aug 6.
Liver transplantation(LT)offers definitive treatment for acute on chronic liver failure(ACLF) patients. This study was done to analyze and compare the outcomes of living donor LT(LDLT) in patients with ACLF versus Chronic liver disease(CLD) and within the grades of ACLF. Factors affecting mortality in patients with ACLF and ACLF grade3 (ACLF3) following LDLT were also derived.
Records of adult LDLT between 1/2/2017 and 30/9/2021 were analyzed. ACLF was classified based on EASL-CLIF definition. Post-transplant outcomes of ACLF were compared with CLD and within ACLF grades. Post LDLT mortality predictors were identified in ACLF and ACLF3 patients.
Out of 853 patients who had LT in that period; 704 patients with CLD and 103 with ACLF [of which 54 (52.42%) had ACLF3] underwent LDLT. The one month and one-year post LDLT mortality was 8.81% and 9.80% in CLD; 19.42% and 31.06% in ACLF; and 25.92% and 38.89% in ACLF3 respectively. On log regression analysis, use of grafts from older donors and pre-operative respiratory failure in recipients was associated with poor survival in ACLF, while respiratory failure was a predictor of poor survival in ACLF3 following LDLT.
Outcomes following LDLT are poorer in ACLF as compared to after CLD. Higher donor age and preoperative respiratory failure with PF Ratio<200 were associated with poor survival post LDLT in ACLF and ACLF3.
肝移植（LT）为慢加急性肝衰竭（ACLF）患者提供了明确的治疗方法。本研究旨在分析和比较 ACLF 患者与慢性肝病（CLD）患者以及 ACLF 分级内接受活体供肝肝移植（LDLT）的患者的结局，并得出影响 ACLF 患者和 ACLF3 患者 LDLT 后死亡率的因素。
分析了 2017 年 2 月 1 日至 2021 年 9 月 30 日期间成人 LDLT 的记录。根据 EASL-CLIF 定义对 ACLF 进行分类。比较了 ACLF 与 CLD 以及 ACLF 分级内的移植后结局。确定了 ACLF 和 ACLF3 患者 LDLT 后死亡的预测因素。
在这段时间内，853 例接受 LT 的患者中，704 例为 CLD，103 例为 ACLF[其中 54 例（52.42%）为 ACLF3]接受了 LDLT。CLD 的一个月和一年 LDLT 后死亡率分别为 8.81%和 9.80%；ACLF 分别为 19.42%和 31.06%；ACLF3 分别为 25.92%和 38.89%。Log 回归分析显示，供者年龄较大和受体术前呼吸衰竭与 ACLF 患者的生存不良相关，而呼吸衰竭是 LDLT 后 ACLF3 患者生存不良的预测因素。
与 CLD 相比，ACLF 患者接受 LDLT 的结局较差。较高的供者年龄和术前呼吸衰竭伴 PF 比值<200 与 ACLF 和 ACLF3 患者 LDLT 后生存不良相关。
