'First week' is the crucial period for deciding living donor liver transplantation in patients with acute-on-chronic liver failure

Choudhury A 1 , Vijayaraghavan R 1 , Maiwall R 1 , Kumar M 1 , Duan Z 2 , Yu C 2 Show all authors , Hamid SS 3 , Jafri W 3 , Butt AS 3 , Devarbhavi H 4 , Ning Q 5 , Ma K 5 , Tan SS 6 , Shukla A 7 , Dhiman R 8 , Duseja A 8 , Taneja S 8 , Eapen CE 9 , Goel A 9 , Treeprasertsuk S 10 , Al-Mahtab M 11 , Ghazinyan H 12 , Kim DJ 13 , Sahu MK 14 , Lee GH 15 , Lesmana LA 16 , Lesmana RC 16 , Shah S 17 , Abbas Z 18 , Sollano JD 19 , Rao PN 20 , Kulkarni A 20 , Shiha G 21 , Shrestha A 22 , Dokmeci A 23 , Yuen MF 24 , Payawal DA 25 , Kalista KF 26 , Prasad VGM 27 , Lau GK 28 , Karim F 29 , Jain P 30 , Kumar G 30 , Arora V 1 , Pamecha V 31 , Sinha P 31 , Sarin SK 32 , APASL ACLF Research Consortium (AARC) for APASL ACLF Working Party

Affiliations 

  • 1 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
  • 2 Translational Hepatology Institute Capital Medical University, Beijing You'an Hospital, Beijing, China
  • 3 Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
  • 4 Department of Gastroenterology and Hepatology, St John Medical College, Bangalore, India
  • 5 Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 6 Department of Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia
  • 7 Department of Hepatology, KEM Hospital and Seth GSMC, Mumbai, India
  • 8 Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 9 Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
  • 10 Department of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 11 Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 12 Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia
  • 13 Centre for Liver and Digestive Diseases, Gangwon-Do, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
  • 14 Department of Gastroenterology and Biliary Sciences, IMS and SUM Hospital, Bhubaneswar, Odisha, India
  • 15 Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
  • 16 Department of Medicine, Medistra Hospital, Jakarta, Indonesia
  • 17 Department of Hepatology, Global Hospital, Mumbai, India
  • 18 Department of Hepatogastroenterology, Ziauddin University, Karachi, Pakistan
  • 19 Department of Hepatology, Cardinal Santos Medical Centre, Manila, Philippines
  • 20 Asian Institute of Gastroenterology, Hyderabad, India
  • 21 Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt
  • 22 Liver Foundation Nepal Sitapaila Height, Kathmandu, Nepal
  • 23 Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
  • 24 Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
  • 25 Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines
  • 26 Division of Hepatobiliary Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia
  • 27 Department of Gastroenterology, VGM Hospital, Coimbatore, India
  • 28 Department of Gastroenterology, Humanity and Health Medical Centre, Hong Kong, China
  • 29 Department of Hepatology, Sir Salimullah Medical College, Dhaka, Bangladesh
  • 30 Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India
  • 31 Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
  • 32 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com
Hepatol Int, 2021 Oct 04.
PMID: 34608586 DOI: 10.1007/s12072-021-10206-6

Abstract

BACKGROUND AND AIMS: Acute-on-chronic liver failure (ACLF) is a rapidly progressive illness with high short-term mortality. Timely liver transplant (LT) may improve survival. We evaluated various indices for assessment of the severity of liver failure and their application for eligibility and timing of living donor LT (LDLT).

METHODS: Altogether 1021 patients were analyzed for the severity and organ failure at admission to determine transplant eligibility and 28 day survival with or without transplant.

RESULTS: The ACLF cohort [mean age 44 ± 12.2 years, males 81%) was of sick patients; 55% willing for LT at admission, though 63% of them were ineligible due to sepsis or organ failure. On day 4, recovery in sepsis and/or organ failure led to an improvement in transplant eligibility from 37% at baseline to 63.7%. Delay in LT up to 7 days led to a higher incidence of multiorgan failure (p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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