Liver transplantation is beneficial regardless of cirrhosis stage or acute-on-chronic liver failure grade: A single-center experience

doi:10.3748/wjg.v28.i40.5881

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 28, Issue 40

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (3917)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-2) series, Tables (1-5) series.

Item

Count

PDF

171

WORD

HTML

1489

Figures (1-2)

287

Tables (1-5)

251

Sum=2236

Featured Article

The chart showing Browse series, Download series.

Item

Count

Browse

201

Download

348

Sum=549

Publishing Process of This Article

Item

Count

Browse

271

Download

861

Sum=1132

Oct 28, 2022 (publication date) through May 1, 2024

Times Cited of This Article

Times Cited (4)

Journal Information of This Article

Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Gastroenterol. Oct 28, 2022; 28(40): 5881-5892
Published online Oct 28, 2022. doi: 10.3748/wjg.v28.i40.5881

Table 1 Patient characteristics (n = 235)

	CC, n = 11 (4.5%)	DC, n= 129 (52.9%)	ACLF, n = 95 (38.9%)	P value
Male gender, n (%)	6 (54.5)	64 (49.6)	47 (49.5)	0.95
Age, yr	57.0 (53.0-59.0)^a	52.0 (43.0-61.0)^c	50.0 (37.0-59.0)^a^,^c	0.02
Liver cirrhosis etiology, n (%)
Autoimmune	1 (9.1)^a	36 (27.9)^c	42 (44.2)^a^,^c	< 0.01
HCV	8 (72.7)^a^,^b	42 (32.6)^b^,^c	13 (13.7)^a^,^c	< 0.0001
Alcoholic liver disease	1 (9.1)	11 (8.5)	9 (9.5)	0.93
NASH	0 (0.0)	7 (5.4)	6 (6.3)	0.88
Cryptogenic	1 (9.1)	22 (17.1)	18 (18.9)	0.76
Other¹	0 (0.0)	11 (8.5)	7 (7.4)	0.84
Comorbidities, n (%)
Type 2 diabetes mellitus	3 (27.3)	22 (17.1)	13 (13.7)	0.44
Primary hypertension	2 (18.2)	20 (15.5)	6 (6.3)	0.06
Pre-transplant clinical data
MELD-Na	11 ± 3^a^,^b	19 ± 4^b^,^c	25 ± 6^a^,^c	< 0.0001
Total bilirubin (mg/dL)	1.18 (1.03-1.45)^a^,^b	3.39 (2.3-5.46)^b^,^c	7.70 (4.14-16.63)^a^,^c	< 0.0001
INR	1.1 (1.1-1.2)^a^,^b	1.5 (1.3-1.7)^b	1.5 (1.3-2.0)^a	< 0.0001
Serum creatinine (mg/dL)	0.67 (0.57-0.71)^a	0.73 (0.61-0.88)^c	0.97 (0.75-1.35)^a^,^c	< 0.0001
Leukocyte count (× 10⁹/L)	2.9 (2.4-3)^a	4 (3.1-5)^c	5.4 (3.8-6.8)^a^,^c	< 0.0001
Disease manifestations², n (%)
Clinical ascites	0 (0.0)^a^,^b	88 (68.2)^b^,^c	88 (92.6)^a^,^c	< 0.0001
Encephalopathy	0 (0.0)^a^,^b	69 (53.5)^b^,^c	80 (84.2)^a^,^c	< 0.0001
Grade 3-4 encephalopathy (West- Haven)	0 (0.0)^a^,^b	7 (5.4)^b^,^c	37 (38.9)^a^,^c	< 0.0001

¹Includes secondary biliary cirrhosis, drug-induced liver injury, and congenital liver diseases.

²Disease manifestations during the whole clinical course until liver transplantation.

Comparisons between groups are shown with superscript letters.

^aSignificant difference between CC and ACLF.

^bSignificant difference between CC and DC.

^cSignificant difference between DC and ACLF.

ACLF: Acute-on-chronic liver failure; CC: Compensated cirrhosis; DC: Decompensated cirrhosis; HCV: Hepatitis C virus; INR: International normalized ratio; MELD Na: Model for End-Stage Liver Disease-Sodium; NASH: Non-alcoholic steatohepatitis.

Table 2 Acute-on-chronic liver failure patients characteristics (n = 95)

	ACLF-1,n = 40 (42.1%)	ACLF-2, n = 33 (34.7%)	ACLF-3, n = 22 (23.2%)	P value
Male gender, n (%)	21 (52.5)	17 (51.5)	11 (50.0)	0.98
Age, yr	55.0 (39.8-60.0)	44.0 (36.5-53.0)	49.0 (37.5-59.3)	0.14
Time to LT since ACLF event	54.0 (21.3-122.8)^a^,^b	31.0 (7.0-59.5)^b	22.0 (9.5-46.8)^a	0.03
Liver cirrhosis etiology, n (%)
Autoimmune	14 (35.0)	17 (51.5)	11 (50.0)	0.30
HCV	9 (22.5)	2 (6.1)	2 (9.1)	0.14
Alcoholic liver disease	2 (5.0)	4 (12.1)	3 (13.6)	0.44
NASH	3 (7.5)	2 (6.1)	1 (4.5)	0.99
Cryptogenic	10 (25.0)	5 (15.2)	3 (13.6)	0.50
Other¹	2 (5.0)	3 (9.1)	2 (9.1)	0.69
ACLF precipitant, n (%)
Bacterial infection	14 (35.0)	16 (48.5)	11 (50.0)	0.39
Gastrointestinal hemorrhage	1 (2.5)	3 (9.1)	1 (4.5)	0.44
Active alcoholism	0 (0.0)	0 (0.0)	0 (0.0)	0.99
Other	10 (25.0)^a	2 (6.1)	0 (0.0)^a	0.01
Unknown	15 (37.5)	12 (36.4)	10 (45.5)	0.77
Organ failures, n (%)
Liver	14 (35.0)^a^,^b	22 (66.7)^b	16 (72.7)^a	< 0.01
Kidney	18 (45.0)	11 (33.3)	14 (63.6)	0.09
Brain	5 (12.5)^a	10 (30.3)	11 (50.0)^a	< 0.01
Coagulation	3 (7.5)^a^,^b	12 (36.4)^b	11 (50.0)^a	< 0.001
Circulation	0 (0.0)^a^,^b	8 (24.2)^b^,^c	14 (63.6)^a^,^c	< 0.0001
Lung	1 (2.5)^a	3 (9.1)	7 (31.8)^a	< 0.01
ACLF event clinical data
MELD-Na	27 ± 4^a^,^b	29 ± 5^b^,^c	35 ± 4^a^,^c	< 0.0001
CLIF-C OF	9 ± 1^a^,^b	10 ± 1^b^,^c	12 ± 2^a^,^c	< 0.0001
CLIF-C ACLF	39 ± 8^a	43 ± 6^c	52 ± 6^a^,^c	< 0.0001
Total bilirubin (mg/dL)	6.31 (2.99-12.91)^a^,^b	13.07 (6.39-22.31)^b	23.08 (10.56-27.76)^a	< 0.001
INR	1.5 (1.2-1.9)^a^,^b	1.9 (1.4-2.5)^b	2.2 (1.7-2.8)^a	< 0.001
Serum creatinine (mg/dL)	1.86 (1.18-2.27)^b	0.93 (0.71-1.99)^b^,^c	2.25 (1.42-2.87)^c	< 0.01
Leukocyte count (× 10⁹/L)	6.55 (4.73-9.43)^a	6.60 (4.55-8.25)^c	8.75 (6.88-13.05)^a^,^c	< 0.01
Pre-transplant clinical data
MELD-Na	23 ± 4^a	25 ± 5^c	29 ± 8^a^,^c	< 0.0001
CLIF-C OF	8 ± 2^a	9 ± 2	10 ± 2^a	0.01
CLIF-C ACLF	37 ± 9	37 ± 8	41 ± 12	0.18
Total bilirubin (mg/dL)	4.58 (2.94-8.60)^a	9.75 (5.40-16.62)	19.59 (5.48-34.11)^a	< 0.01
INR	1.4 (1.3-1.7)	1.6 (1.3-2.2)	1.9 (1.4-2.6)	0.05
Serum creatinine (mg/dL)	0.96 (0.75-1.29)^a	0.88 (0.72-1.17)^c	1.23 (0.94-1.95)^a^,^c	< 0.01
Leukocyte count (× 10⁹/L)	4.40 (3.23-6.70)	4.80 (2.90-6.30)	4.75 (2.48-10.45)	0.92

¹Includes secondary biliary cirrhosis, drug-induced liver injury, and congenital liver diseases.

Comparisons between groups are shown with superscript letters.

^aSignificant difference between CC and ACLF.

^bSignificant difference between CC and DC.

^cSignificant difference between DC and ACLF.

ACLF: Acute-on-chronic liver failure; CLIF-C OF: Chronic Liver Failure Consortium: Organ Failure score; CLIF-C ACLF: Chronic Liver Failure Consortium: acute-on-chronic liver failure score; HCV: Hepatitis C virus; INR: International normalized ratio; MELD Na: Model for End-Stage Liver Disease-Sodium; NASH: Non-alcoholic steatohepatitis.

Table 3 Posttransplant outcomes (n = 235)

	CC, n = 11 (4.5%)	DC, n = 129 (52.9%)	ACLF, n = 95 (38.9%)	P value
ICU stay (d)	2.0 (1.0-4.0)	2.0 (1.5-4.0)	3.0 (2.0-5.0)	0.05
Hospital stay (d)	6.0 (3.0-7.0)^a	7.0 (4.5-10.0)	8.0 (6.0-13.0)^a	0.01
Any type of complication, n (%)	7 (63.6)	105 (81.4)	85 (89.5)	0.05
Infectious complications, n (%)	1 (9.1)^a	38 (29.5)^b	47 (49.5)^a^,^b	< 0.01
Complications (Clavien-Dindo), n (%)
I	4 (36.4)	17 (13.2)	19 (20.0)	0.08
II	2 (18.2)	51 (39.5)	32 (33.7)	0.31
III	1 (9.1)	14 (10.9)	17 (17.9)	0.27
IV	0 (0.0)	9 (7.0)	12 (12.6)	0.23
V	0 (0.0)	14 (10.9)	5 (5.3)	0.24

Comparisons between groups are shown with superscript letters.

^aSignificant difference between CC and ACLF.

^bSignificant difference between CC and DC.

^cSignificant difference between DC and ACLF.

ACLF: Acute-on-chronic liver failure; CC: Compensated cirrhosis; DC: Decompensated cirrhosis; ICU: Intensive care unit.

Table 4 Acute-on-chronic liver failure posttransplant outcomes (n = 95)

	ACLF-1, n = 40 (42.1%)	ACLF-2, n = 33 (34.7%)	ACLF-3, n = 22 (23.2%)	P value
ICU stay (d)	3.0 (2.0-4.0)	3.0 (2.0-6.0)	3.0 (2.0-6.0)	0.68
Hospital stay (d)	8.0 (5.0-11.8)	8.0 (6.0-15.5)	6.0 (5.8-14.3)	0.54
Any type of complication, n (%)	35 (87.5)	31 (93.9)	19 (86.4)	0.58
Infectious complications, n (%)	20 (50.0)	15 (45.5)	12 (54.5)	0.80
Complications (Clavien-Dindo), n (%)
I	7 (17.5)	6 (18.2)	6 (27.3)	0.62
II	17 (42.5)	11 (33.3)	4 (18.2)	0.15
III	5 (12.5)	7 (21.2)	5 (22.7)	0.50
IV	4 (10.0)	6 (18.2)	2 (9.1)	0.49
V	2 (5.0)	1 (3.0)	2 (9.1)	0.61

ACLF: Acute-on-chronic liver failure; ICU: Intensive care unit.

Table 5 Posttransplant survival overall and by acute-on-chronic liver failure grade, n (%)

	CC, n = 11 (4.5%)	DC, n = 129 (52.9%)	ACLF, n = 95 (38.9%)	P value	ACLF-1, n = 40 (42.1%)	ACLF-2, n = 33 (34.7%)	ACLF-3, n = 22 (23.2%)	P value
DRI	1.41 (1.36-2.26)	1.38 (1.21-1.53)	1.32 (1.19-1.54)	0.13	1.43 (1.24-1.62)	1.27 (1.20-1.43)	1.38 (1.20-1.69)	0.08
30-d mortality	0 (0.0)	10 (7.8)	3 (3.2)	0.38	1 (2.5)	0 (0.0)	2 (9.1)	0.17
3-mo mortality	0 (0.0)	15 (11.6)	6 (6.3)	0.30	3 (7.5)	1 (3.0)	2 (9.1)	0.65
1-yr survival	11 (100)	114 (88.4)	87 (91.6)	0.60	35 (87.5)	32 (97.0)	20 (90.9)	0.40
Overall survival¹	10 (90.9)	112 (86.8)	80 (84.2)	0.90	32 (80.0)	31 (93.9)	17 (77.3)	0.15

¹Survival was analyzed until 6 years of follow-up, when the study was ended.

ACLF: Acute-on-chronic liver failure; CC: Compensated cirrhosis; DC: Decompensated cirrhosis.

Citation: Cervantes-Alvarez E, Vilatoba M, Limon-de la Rosa N, Mendez-Guerrero O, Kershenobich D, Torre A, Navarro-Alvarez N. Liver transplantation is beneficial regardless of cirrhosis stage or acute-on-chronic liver failure grade: A single-center experience. World J Gastroenterol 2022; 28(40): 5881-5892
URL: https://www.wjgnet.com/1007-9327/full/v28/i40/5881.htm
DOI: https://dx.doi.org/10.3748/wjg.v28.i40.5881