Recipient Selection and Viral Infections (Videos Available)

Tuesday July 03, 2018 from 08:30 to 09:30

Room: N-101

400.1 Predictive factors for death on a long waiting list for liver transplantation after an episode of acute on chronic liver failure (Video Available)

Speranta Iacob, Romania

Fundeni Clinical Institute

Abstract

Predictive Factors for Death on a Long Waiting List for Liver Transplantation after an Episode of Acute on Chronic Liver Failure

Speranta Iacob1, Mihaela Lita1, Dana Tomescu1, Gabriela Droc1, Corina Pietrareanu1, Doina Hrehoret1, Vlad Brasoveanu1, Razvan Iacob1, Cristian Gheorghe1, Irinel Popescu1, Liana Gheorghe1.

1Fundeni Clinical Institute, Bucharest, Romania

Introduction: Acute on chronic liver failure (ACLF) occurs in the context of a systemic inflammatory response and is associated with a high short-term mortality rate, depending on the number of organ failures (CLIF-OF scoring system). Liver transplantation (LT) can provide the prospect of a definitive treatment and survival benefit in patients with a high risk of early death.
Material and Methods: 255 patients with liver cirrhosis included on the waiting list (WL) between 2015 and 2017 were analyzed. 26.8% of patients had ACLF while on WL (stage 1 – 11.4%, stage 2 -7.1% and stage 3- 7.3% according to EASL CLIF classification). 33.8% of patients were transplanted during this time period of follow-up. Mean MELD score at inclusion on WL was 14.9±5.7. Cox Proportional Hazard Model Survival Analysis was performed to identify predictive factors of death on the WL after an ACLF episode.
Results: 19.1% of patients died while on the WL. As risk factors for death while on the WL after and ACLF episode we identified: grade of ACLF while on the WL (HR=2.91, p<0.0001), MELD at inclusion (HR=1.07, p=0.01), MELD score at ACLF (HR=1.15, p<0.0001), INR >2.5 (HR=4.42, p=0.0002), total bilirubin >12mg/dL (HR=2.08, p=0.009), hepatic encephalopathy grade III-IV (HR=3.66, p=0.0002), respiratory failure (HR=5.09, p=0.0001), circulatory failure (HR=3.19, p=0.03), other type of infections while on the WL (excepting spontaneous bacterial peritonitis) (HR=8.21, p=0.001). LT was a protective factor for death (HR=0.05, p=0.005). Patient survival at 3 months on WL was: 97.5% without any ACLF episode, 78% after an episode of ACLF stage 1, 76.6% after ACLF stage 2 and 59.6% after ACLF stage 3 (p<0.0001). 30.3% of the patients with LT had an episode of ACLF prior to LT compared to 25.3% of patients with ACLF and without LT (p=0.41). Median time from an episode of ACLF to LT was 4.9months. There was no difference regarding 1 and respectively 12 months survival of patients with or without ACLF prior to LT (p=0.97).
Conclusions: Independent predictors of death on WL after an ACLF episode were grade of ACLF and MELD score at inclusion, while LT is a protective factor for death on the WL. Short term survival after LT is similar between patients with and without ACLF while on the WL.



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