Excellent Outcome in Living Donor Liver Transplantation: Treating Patients With Acute‐on‐Chronic Liver Failure : Liver Transplantation

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Original Articles: PERITRANSPLANT AND POSTTRANSPLANT MANAGEMENT AND OUTCOMES

Excellent Outcome in Living Donor Liver Transplantation: Treating Patients With Acute‐on‐Chronic Liver Failure

Wang, Yu‐Chen; Yong, Chee‐Chien; Lin, Chih‐Che*; Alam, Humaira; Naseer, Faisal; Lin, Yu‐Hung; Yeh, Cheng‐Hsi; Wang, Shih‐Ho; Lin, Tsan‐Shiun; Lin, Ting‐Lung; Lee, Wei‐Feng; Chan, Yi‐Chia; Wang, Chih‐Chi; Chen, Chao‐Long

Author Information

1Liver Transplantation Center and Department of SurgeryKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan

2Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan

3Azra Naheed Medical College LahorePunjabPakistan

4Liver Transplant UnitDow University HospitalDow University of Health SciencesKarachiPakistan

* Address reprint requests to Chih‐Che Lin, M.D., Ph.D., Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Ta‐Pei Road, Niao‐Song, Kaohsiung 833, Taiwan. Telephone: +886‐77‐317123 ext.: 8092; FAX: +886‐7‐7324855; E‐mail: [email protected]

Potential conflict of interest: Nothing to report.

Liver Transplantation 27(11):p 1633-1643, November 2021. | DOI: 10.1002/lt.26096

Abstract

Acute‐on‐chronic liver failure (ACLF) is a fatal condition, and liver transplantation (LT) is a vital option for these patients. However, the result of living donor LT (LDLT) for ACLF is not well investigated. This study investigated the outcomes of LDLT in patients with ACLF compared with patients without ACLF. This was a single‐center, retrospective, matched case‐control study. From July 2002 to March 2017, a total of 112 patients with ACLF who underwent LDLT were enrolled according to the consensus of the Asian Pacific Association for the Study of the Liver. A total of 224 patients were selected for control comparison (non‐ACLF) with demographic factors (sex, age, and body mass index) matched (1:2). Patients with ACLF were stratified into ACLF 1, 2, and 3 categories according to the number of organ failures based on the Chronic Liver Failure–Sequential Organ Failure Assessment score. Survival and surgical outcomes after LDLT were analyzed. The Model for End‐Stage Liver Disease and Child‐Turcotte‐Pugh scores in the ACLF group were significantly higher than those in the non‐ACLF group (P < 0.001). The 90‐day, 3‐year, and 5‐year survival rates in the ACLF and non‐ACLF groups were 97.3%, 95.5%, 92.9%, respectively, and 96.9%, 94.2%, and 91.1%, respectively (P = 0.58). There was more intraoperative blood loss in the ACLF group than in the non‐ACLF group (P < 0.001). The other postoperative complications were not significantly different between the groups. A total of 20 patients (17.9%) in the ACLF group presented with 3 or more organ system dysfunctions (ACLF 3), and the 90‐day, 3‐year, and 5‐year survival rates were comparable with those of ACLF 1 and ACLF 2 (P = 0.25). In carefully selected patients, LDLT gives excellent outcomes in patients with ACLF regardless of the number of organs involved. Comprehensive perioperative care and timely transplantation play crucial roles in saving the lives of patients with ACLF.

Copyright © 2021 by the American Association for the Study of Liver Diseases.

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