Outcome after wait-listing for emergency liver transplantation in acute liver failure: A single centre experience

• Published in: Journal of hepatology 2009-02, Vol.50 (2), p.306-313
• Main Authors: Bernal, William, Cross, Timothy J.S, Auzinger, Georg, Sizer, Elizabeth, Heneghan, Michael A, Bowles, Matthew, Muiesan, Paulo, Rela, Mohammed, Heaton, Nigel, Wendon, Julia, O’Grady, John G
• Format: Article
• Language: English
• Subjects: ABO Blood-Group System - immunology; Acetaminophen - poisoning; Adult; Age Factors; Biological and medical sciences; Critical illness; Emergencies; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver Failure, Acute - surgery; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Multiple organ failure; Other diseases. Semiology; Paracetamol; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Waiting Lists
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2008.09.012

Background/Aims Though emergency liver transplantation (ELT) is an established treatment for severe acute liver failure (ALF), outcomes are inferior to elective surgery. Despite prioritization, many patients deteriorate, becoming unsuitable for ELT. Methods We examined a single-centre experience of 310 adult patients with ALF registered for ELT over a 10-year period to determine factors associated with failure to transplant, and in those patients undergoing ELT, those associated with 90-day mortality. Results One hundred and thirty-two (43%) patients had ALF resulting from paracetamol and 178 (57%) from non-paracetamol causes. Seventy-four patients (24%) did not undergo surgery; 92% of these died. Failure to transplant was more likely in patients requiring vasopressors at listing (hazard ratio 1.9 (95% CI 1.1–3.6)) paracetamol aetiology (2.5 (1.4–4.6)) but less likely in blood group A (0.5 (0.3–0.9)). Post-ELT survival at 90-days and one-year increased from 66% and 63% in 1994–1999 to 81% and 79% in 2000–2004 ( p < 0.01). Four variables were associated with post-ELT mortality; age >45 years (3 (1.7–5.3)), vasopressor requirement (2.2 (1.3–3.8), transplantation before 2000 (1.9 (1.1–3.3)) and use of high-risk grafts (2.3 (1.3–4.2). Conclusions The data indicate improved outcomes in the later era, despite higher level patient dependency and greater use of high-risk grafts, through improved graft/recipient matching.