Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS)

被引：145

作者：

Belli, Luca S. ^{[1
]}

Duvoux, Christophe ^{[2
]}

Artzner, Thierry ^{[3
]}

Bernal, William ^{[4
]}

Conti, Sara ^{[5
,6
]}

Cortesi, Paolo A. ^{[5
,6
]}

Sacleux, Sophie-Caroline ^{[7
,8
]}

Pageaux, George-Philippe ^{[9
]}

Radenne, Sylvie ^{[10
]}

Trebicka, Jonel ^{[11
,30
]}

Fernandez, Javier ^{[12
,13
]}

Perricone, Giovanni ^{[1
]}

Piano, Salvatore ^{[14
]}

Nadalin, Silvio ^{[15
]}

Morelli, Maria C. ^{[16
]}

Martini, Silvia ^{[17
]}

Polak, Wojciech G. ^{[18
]}

Zieniewicz, Krzysztof ^{[19
]}

Toso, Christian ^{[20
]}

Berenguer, Marina ^{[21
,22
]}

Iegri, Claudia ^{[23
]}

Invernizzi, Federica ^{[24
]}

Volpes, Riccardo ^{[25
]}

Karam, Vincent ^{[26
]}

Adam, Rene ^{[26
]}

Faitot, Francois ^{[3
]}

Rabinovich, Liane ^{[4
]}

Saliba, Faouzi ^{[7
,8
]}

Meunier, Lucy ^{[9
]}

Lesurtel, Mickael ^{[10
]}

Uschner, Frank E. ^{[11
]}

Fondevila, Costantino ^{[12
,13
]}

Michard, Baptiste ^{[3
]}

Coilly, Audrey ^{[7
,8
]}

Meszaros, Magdalena ^{[9
]}

Poinsot, Domitille ^{[10
]}

Schnitzbauer, Andreas ^{[11
]}

De Carlis, Luciano G. ^{[27
,28
]}

Fumagalli, Roberto ^{[29
]}

Angeli, Paolo ^{[14
]}

Arroyo, Vincente ^{[30
]}

Jalan, Rajiv ^{[30
,31
]}

机构：

[1] ASST GOM Niguarda, Hepatol & Gastroenterol Unit, Piazza Osped Maggiore 3, I-20162 Milan, Italy

[2] Hop Henri Mondor, Serv Hepatol, Creteil, France

[3] CHRU Strasbourg, Hop Hautepierre, Strasbourg, France

[4] Kings Coll Hosp London, Inst Liver Studies, Liver Intens Therapy Unit, London, England

[5] IRCCS Multi Med, Value Based Healthcare Unit, Sesto San Giovanni, Italy

[6] Univ Milano Bicocca, Res Ctr Publ Hlth CESP, Monza, Italy

[7] Hop Paul Brousse, AP HP, Ctr Hepatobiliaire, Villejuif, France

[8] Univ Paris Saclay, Unite INSERM 1193, Paris, France

[9] Univ Montpellier, St Eloi Hosp, Hepatol & Liver Transplantat Unit, Dept Hepatogastroenterol, Montpellier, France

[10] HCL Hop Croix Rousse, Hepatol & Liver Transplantat Unit, Dept Hepatogastroenterol, Lyon, France

[11] Goethe Univ, Dept Internal Med, Translat Hepatol, Frankfurt, Germany

[12] Univ Barcelona, IDIBAPS, Hosp Clin, Inst Digest & Metab Dis,Liver ICU,Liver Unit, Barcelona, Spain

[13] CIBERehd, Barcelona, Spain

[14] Univ Padua, Dept Med, Unit Internal Med & Hepatol UIMH, Padua, Italy

[15] Univ Hosp Tubingen, Dept Gen Visceral & Transplant Surg, Tubingen, Germany

[16] IRCCS Azienda Osped Univ Bologna, Bologna, Italy

[17] Univ Torino, Gastrohepatol Unit, Azienda Osped Univ, Citta Salute & Sci Torino, Turin, Italy

[18] Erasmus MC, Transplant Inst, Univ Med Ctr Rotterdam, Dept Surg,Div HPB & Transplant Surg, Rotterdam, Netherlands

[19] Med Univ Warsaw, Dept Gen Transplant & Liver Surg, Warsaw, Poland

[20] Geneva Univ Hosp, Dept Surg, Div Abdominal Surg, Geneva, Switzerland

[21] La Fe Univ Hosp, Ciberehd, Hepatol & Liver Transplantat Unit, Valencia, Spain

[22] La Fe Univ Hosp, Fac Med, Valencia, Spain

[23] Papa Giovanni XXIII Hosp, Gastroenterol Unit, Bergamo, Italy

[24] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Div Gastroenterol & Hepatol, CRC AM & A Migliavacca Ctr Liver Dis, Milan, Italy

[25] ISMETT IRCCS, Hepatol & Gastroenterol Unit, Palermo, Italy

[26] Ctr Hepatobiliaire Hop Univ Paul Brousse, European Liver Transplant Registry, Villejuif, France

[27] ASST GOM Niguarda, Gen Surg & Transplantat Unit, Milan, Italy

[28] Univ Milano Bicocca, Sch Med & Surg, Milan, Italy

[29] Univ Milano Bicocca, Sch Med & Surg, ASST GOM Niguarda, Dept Anesthesia,Crit Care, Milan, Italy

[30] European Fdn Study Chron Liver Failure EF Clif, Barcelona 08021, Spain

[31] UCL Med Sch, Inst Liver & Digest Hlth, Liver Failure Grp, London, England

来源：

JOURNAL OF HEPATOLOGY | 2021年 / 75卷 / 03期

关键词：

Acute-on-Chronic Liver Failure; Liver transplantation; Waiting list; Predictive factors; Multi-drug resistant organisms; MORTALITY;

D O I：

10.1016/j.jhep.2021.03.030

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

Background & Aims: Liver transplantation (LT) has been proposed as an effective salvage therapy even for the sickest patients with acute-on-chronic liver failure (ACLF). This large collaborative study was designed to assess the current clinical practice and outcomes of patients with ACLF who are wait-listed for LT in Europe. Methods: This was a retrospective study including 308 consecutive patients with ACLF, listed in 20 centres across 8 European countries, from January 2018 to June 2019. Results: A total of 2,677 patients received a LT: 1,216 (45.4%) for decompensated cirrhosis. Of these, 234 (19.2%) had ACLF at LT: 58 (4.8%) had ACLF-1, 78 (6.4%) had ACLF-2, and 98 (8.1%) had ACLF-3. Wide variations were observed amongst countries: France and Germany had high rates of ACLF-2/3 (27-41%); Italy, Switzerland, Poland and the Netherlands had medium rates (9-15%); and the United Kingdom and Spain had low rates (3-5%) (p <0.0001). The 1-year probability of survival after LT for patients with ACLF was 81% (95% CI 74-87). Pre-LT arterial lactate levels >4 mmol/L (hazard ratio [HR] 3.14; 95% CI 1.37-7.19), recent infection from multidrug resistant organisms (HR 3.67; 95% CI 1.63-8.28), and renal replacement therapy (HR 2.74; 95% CI 1.37-5.51) were independent predictors of post-LT mortality. During the same period, 74 patients with ACLF died on the waiting list. In an intention-to-treat analysis, 1-year survival of patients with ACLF on the LT waiting list was 73% for ACLF-1 or-2 and 50% for ACLF-3. Conclusion: The results reveal wide variations in the listing of patients with ACLF in Europe despite favourable post-LT survival. Risk factors for mortality were identified, enabling a more pre-cise prognostic assessment of patients with ACLF. Lay summary: Acute-on-chronic liver failure (ACLF) is a severe clinical condition for which liver transplantation is an effective therapeutic option. This study has demonstrated that in Europe, referral and access to liver transplantation (LT) for patients with ACLF needs to be harmonised to avoid inequities. Post-LT survival for patients with ACLF was >80% after 1 year and some factors have been identified to help select patients with favourable outcomes. (C) 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All reserved.

引用

页码：610 / 622

页数：14

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