Liver transplantation for acute-on-chronic liver failure

Abstract

Purpose: To evaluate the outcome of liver transplantation for acute-on-chronic liver failure.

Patients and methods: From November 1991 to December 2007, 517 patients underwent liver transplantation at Queen Mary Hospital, Hong Kong. Among them, 149 had acute-on-chronic liver failure as defined in the recent Asian Pacific Association for the Study of Liver Consensus Meeting. Their clinical data were reviewed and their survival outcomes were compared with those of patients who underwent liver transplantation for fulminant hepatic failure and for cirrhosis only in the same period.

Results: The patients with acute-on-chronic liver failure included 50 patients having acute exacerbation of chronic hepatitis B and 99 cirrhotic patients with acute deterioration. Their median model for end-stage liver disease scores were 35 and 37, respectively. Preoperative infection (35%), hepatorenal syndrome (38%), and respiratory failure (28.8%) were common. One hundred and three patients received living donor liver grafts and 46 patients received deceased donor liver grafts. The hospital mortality rate was 4.7%. The 5-year survival rates were 93.2% for patients with acute exacerbation of chronic hepatitis B and 90.5% for cirrhotic patients with acute deterioration. The results were similar to those of the patients with fulminant hepatic failure (n = 37) and the patients having cirrhosis only (n = 301).

Conclusions: Liver transplantation for acute-on-chronic liver failure is life-saving, and the survival rates it attains are similar to those attained by transplantation for other liver conditions.

Fig. 1

Median preoperative and postoperative a serum total bilirubin levels, b international normalized ratio (INR) values, c platelet counts, and d creatinine levels of the four groups of patients

Fig. 2

Cumulative survival curves of non-hepatocellular carcinoma cirrhotic patients with and without acute deterioration

Fig. 3

Cumulative survival curves of a patients with fulminant hepatic failure, b patients with acute exacerbation of chronic hepatitis B, c cirrhotic patients with acute deterioration, and d patients with cirrhosis only. Comparison between patients who underwent deceased donor liver transplantation (DDLT) and those who underwent living donor liver transplantation (LDLT)