Pretransplant ascites and encephalopathy and their influence on survival and liver graft rejection in alcoholic cirrhosis disease

Abstract

Introduction: The Child-Pugh and model for end-stage liver disease (MELD) scores are widely used to predict the outcomes of liver transplant (LT). Both have similar prognostic values in most cases, although their benefits might differ in some specific conditions. The aim of our study was to analyze the influence of pre-transplant ascites and encephalopathy in post-transplant liver rejection development and survival in alcohol cirrhosis (AC) patients undergoing LT to determine the usefulness of the Child-Pugh score for the assessment of prognosis in such patients.

Material and methods: Two hundred and eighty-one AC patients, classified according to viral infections and pre-transplant complications, were analyzed. Acute (AR) and chronic (CR) liver rejections and Child-Pugh, MELD and albumin-bilirubin (ALBI) scores were studied in all cases.

Results: Similar AC rejection percentages were observed in ascites or encephalopathy groups (18.5% and 16.5%, p = 0.735), although a higher but not statistically significant AC rate was observed in patients with grade III ascites (p = 0.777) and with grade II encephalopathy (p = 0.089). Chronic rejection was only developed by 9.1% of AC patients, regardless of the presence of ascites (6.2%) or encephalopathy (5.5%). The presence of ascites and encephalopathy complications did not seem to influence post-transplant survival. Neither the Child-Pugh nor the ALBI score can be considered the best for predicting patient survival in the short or long term.

Conclusions: Ascites and encephalopathy do not seem to influence AC or CR in patient survival, regardless of the presence of viral infections, so in our study neither the Child-Pugh nor ALBI score seems to be the best score to predict the outcomes of these patients.

Keywords: alcoholic cirrhosis; ascites; hepatic encephalopathy; hepatotoxicity; human clinical toxicology; liver rejection; liver transplantation.

Figure 1

Kaplan-Meier patient survival curves of alcoholic cirrhosis patients with ascites or encephalopathy and concomitant viral infection. A–D – Kaplan-Meier patient survival curves of the total group of male alcoholic patients with ascites, and with and without associated viral infections. E–H – Kaplan-Meier patient survival curves of the total group of male alcoholic patients with encephalopathy, and with and without associated viral infections. Viral group included HCV and HBV HCV – hepatitis C virus, HBV – hepatitis B virus, n – total number of patients included in each group considered.

Figure 2

Kaplan-Meier patient survival curves of alcoholic cirrhosis patients according to ALBI and Child-Pugh scores. A, B) Kaplan-Meier patient short-term survival curves of the total group of male alcoholic patients according to ALBI (A) and Child-Pugh score (B). C–E) Kaplan-Meier patient long-term survival curves of the total group of patients and with and without associated viral infections according to ALBI score. F–H) Kaplan-Meier patient long-term survival curves of the total group of patients and with and without associated viral infections according to Child-Pugh score. Viral group included HCV and HBV HCV – hepatitis C virus, HBV – hepatitis B virus, n – total number of patients included in each group considered