Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Medicine, Hepatology and Liver Transplantation Unit, Hospital Universitario y Politécnico La Fe, IIS La Fe, Valencia, Spain.
Liver Transpl. 2024 Dec 1;30(12):1217-1225. doi: 10.1097/LVT.0000000000000402. Epub 2024 May 23.
Acute liver failure (ALF) is an acute liver dysfunction with coagulopathy and HE in a patient with no known liver disease. As ALF is rare and large clinical trials are lacking, the level of evidence regarding its management is low-moderate, favoring heterogeneous clinical practice. In this international multicenter survey study, we aimed to investigate the current practice and management of patients with ALF. An online survey targeting physicians who care for patients with ALF was developed by the International Liver Transplantation Society ALF Special-Interest Group. The survey focused on the management and liver transplantation (LT) practices of ALF. Survey questions were summarized overall and by geographic region. A total of 267 physicians completed the survey, with a survey response rate of 21.36%. Centers from all continents were represented. More than 90% of physicians specialized in either transplant hepatology/surgery or anesthesiology/critical care. Two hundred fifty-two (94.4%) respondents' institutions offered LT. A total of 76.8% of respondents' centers had a dedicated liver-intensive or transplant-intensive care unit ( p < 0.001). The median time to LT was within 48 hours in 12.7% of respondents' centers, 72 hours in 35.6%, 1 week in 37.6%, and more than 1 week in 9.6% ( p < 0.001). Deceased donor liver graft (49.6%) was the most common type of graft offered. For consideration of LT, 84.8% of physicians used King's College Criteria, and 41.6% used Clichy Criteria. Significant differences were observed between Asia, Europe, and North America for offering LT, number of LTs performed, volume of patients with ALF, admission to a dedicated intensive care unit, median time to LT, type of liver graft, monitoring HE and intracranial pressure, management of coagulopathy, and utilization of different criteria for LT. In our study, we observed significant geographic differences in the practice and management of ALF. As ALF is rare, multicenter studies are valuable for identifying global practice.
急性肝衰竭（ALF）是一种在无已知肝病的患者中出现肝功能障碍伴凝血障碍和肝性脑病的急性肝脏疾病。由于 ALF 较为罕见，且缺乏大规模临床试验，因此针对其管理的循证医学证据水平较低，支持异质性临床实践。在这项国际性多中心调查研究中，我们旨在调查 ALF 患者的当前治疗和管理情况。国际肝脏移植学会 ALF 特别兴趣小组开发了一项针对治疗 ALF 患者的医生的在线调查。该调查侧重于 ALF 的管理和肝移植（LT）实践。调查问题总体和按地理区域进行了总结。共有 267 名医生完成了调查，调查响应率为 21.36%。所有大洲的中心均有代表。超过 90%的医生专门从事移植肝/外科或麻醉学/重症监护。252 名（94.4%）受访者所在机构提供 LT。共有 76.8%的受访者中心设有专门的肝强化或移植强化护理单元（p<0.001）。12.7%的受访者中心的 LT 中位时间在 48 小时内，35.6%的受访者中心中位时间在 72 小时内，37.6%的受访者中心中位时间在 1 周内，9.6%的受访者中心中位时间超过 1 周（p<0.001）。供体肝移植中最常见的是脑死亡供体肝移植（49.6%）。84.8%的医生使用 King's College 标准，41.6%的医生使用 Clichy 标准来考虑 LT。在提供 LT、进行的 LT 数量、ALF 患者数量、入住专门的重症监护病房、LT 的中位时间、肝移植类型、监测 HE 和颅内压、凝血障碍的管理以及不同的 LT 标准的使用方面，亚洲、欧洲和北美之间存在显著差异。在我们的研究中，我们观察到 ALF 的实践和管理存在显著的地域差异。由于 ALF 较为罕见，多中心研究对于确定全球实践具有重要价值。
