Outcome after wait-listing for emergency liver transplantation in acute liver failure: A single centre experience☆

Background/Aims

Though emergency liver transplantation (ELT) is an established treatment for severe acute liver failure (ALF), outcomes are inferior to elective surgery. Despite prioritization, many patients deteriorate, becoming unsuitable for ELT.

Methods

We examined a single-centre experience of 310 adult patients with ALF registered for ELT over a 10-year period to determine factors associated with failure to transplant, and in those patients undergoing ELT, those associated with 90-day mortality.

Results

One hundred and thirty-two (43%) patients had ALF resulting from paracetamol and 178 (57%) from non-paracetamol causes. Seventy-four patients (24%) did not undergo surgery; 92% of these died. Failure to transplant was more likely in patients requiring vasopressors at listing (hazard ratio 1.9 (95% CI 1.1–3.6)) paracetamol aetiology (2.5 (1.4–4.6)) but less likely in blood group A (0.5 (0.3–0.9)). Post-ELT survival at 90-days and one-year increased from 66% and 63% in 1994–1999 to 81% and 79% in 2000–2004 (p<0.01). Four variables were associated with post-ELT mortality; age >45 years (3 (1.7–5.3)), vasopressor requirement (2.2 (1.3–3.8), transplantation before 2000 (1.9 (1.1–3.3)) and use of high-risk grafts (2.3 (1.3–4.2).

Conclusions

The data indicate improved outcomes in the later era, despite higher level patient dependency and greater use of high-risk grafts, through improved graft/recipient matching.

Abbreviations: ELT, emergency liver transplantation, ALF, acute liver failure, HR, hazard ratio, BMI, body mass index, UKT, United Kingdom transplant, LITU, liver intensive therapy unit, INR, international normalised ratio, KCH, King’s College Hospital, RRT, renal replacement therapy, AUROC, area under receiver operating characteristic curve, HE, hepatic encephalopathy, ICH, intra-cranial Hypertension, CLD, chronic liver disease, MOF, multiple organ failure, HAT, hepatic artery thrombosis

Keywords: Multiple organ failure, Paracetamol, Critical illness