Pre-transplant predictors of 3-Month survival following liver transplantation for acute liver failure in adult and pediatric patients in Türkiye

Abstract

This multicenter retrospective study analyzed 336 patients (236 adults, 100 children) who underwent liver transplantation (LT) for acute liver failure (ALF) between 2002 and 2019 across 14 centers in Türkiye. The aim was to evaluate pretransplant factors influencing short-term posttransplant survival. Median MELD and PELD scores were 31 and 30, respectively. The most common ALF etiologies were viral, indeterminate, and drug-induced causes. Living donor liver transplantation (LDLT) was more common in children (86.0%) than adults (57.2%). Mean posttransplant survival was 166±9 months in children and 117±6 months in adults. In adults, LDLT significantly improved survival compared to deceased donor LT (DDLT), with survival of 135 vs. 89 months (p=0.0012). Although pediatric LDLT recipients had longer mean survival than DDLT recipients (167 vs. 132 months), this difference was not statistically significant (p=0.5959). Three-month mortality was associated with low albumin and grade 4 hepatic encephalopathy (HE) in children. In adults, independent predictors of early mortality included DDLT, serum sodium >140 mEq/L, MELD >35, pH <7.3, and grade 4 HE. Our data suggest that LDLT may offer a survival advantage, particularly in adults with ALF. Identifying pretransplant risk factors is essential for improving early outcomes and guiding clinical decision-making.

Keywords: Acute liver failure; Liver transplantation; Living donor.

Fig. 1

Cumulative survival of adults (A) and children (B).

Fig. 3

Kaplan–Meier survival curves demonstrating the association between 3-month post-transplant mortality and key predictors identified in multivariable regression analysis, including transplantation type (A), hepatic encephalopathy (B), MELD score (C), serum sodium level (D), and arterial pH (E). Log-rank tests were used to compare survival distributions across groups.

Fig. 2

In adult patients, survival in LDLT and DDLT patients before (A) and after matching for pretransplant age, creatinine, ammonia, and hepatic encephalopathy (B).