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Pre-operative CT scan helps predict outcome after liver transplantation for acute-on-chronic grade 3 liver failure

  • Gastrointestinal
  • Published:
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Abstract

Objectives

The aim of this study was to identify the prognostic value of pre-operative imaging to predict post-transplantation survival in critically ill cirrhotic patients with severe acute-on-chronic liver failure (ACLF).

Methods

Patients with grade 3 ACLF who underwent liver transplantation between January 2010 and January 2020 and with available contrast-enhanced abdominal computed tomography (CT) performed less than 3 months before LT were retrospectively included (n = 82). Primary endpoint was 1-year mortality. Imaging parameters (sarcopenia, liver morphology and volumetry, and signs of portal hypertension) were screened and tested to build a prognostic score.

Results

In the multivariate analysis, three independent CT-derived prognostic factors were found: splenomegaly (p = 0.021; HR = 5.6 (1.29–24.1)), liver atrophy (p = 0.05; HR = 2.93 (1.01–10.64)), and vena cava diameter ratio (p < 0.0001; HR = 12.7 (3.4–92)). A simple prognostic score was proposed, based on the presence of splenomegaly (5 points), liver atrophy (5 points), and vena cava diameter ratio < 0.2 (12 points). A cutoff at 10 points distinguished a high-risk group (score > 10) from a low-risk group (score ≤ 10) with 1-year survival of 27% vs. 67% respectively (p < 0.001). It was found to be an independent predictive factor in association with the Transplantation for ACLF3 Model (TAM) score.

Conclusion

Pre-transplantation contrast-enhanced abdominal CT has a significant impact on selection of patients in ACLF3 in order to predict 1-year survival after LT.

Key Points

• Splenomegaly, liver atrophy, and vena cava diameter ratio are independent CT-derived prognostic factors after transplantation for severe acute-on-chronic liver failure.

• A simple CT-based prognostic score is an independent predictive factor, complementary to clinical and biological parameters.

• The use of the CT-derived score allows stratification based on 1-year mortality for patients with otherwise uncertain prognosis with clinical and biological parameters alone.

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Abbreviations

ACLF3:

Acute-on-chronic liver failure grade 3

CLIF-OF:

Chronic liver failure - Organ Failure

CLIF-SOFA:

Chronic liver failure - Sequential Organ Failure Assessment

CT:

Computed tomography

EASL-CLIF:

European Foundation for the study of chronic liver failure

HCC:

Hepatocarcinoma

HR:

Hazard ratio

IVC:

Inferior vena cava

LT:

Liver transplantation

MELD:

Model for End-stage Liver Disease

nPMA:

Normalized psoas muscle area

nTMA:

Normalized total skeletal muscle area

PMA:

Psoas muscle area

SD:

Standard deviation

TAM:

Transplantation for ACLF3 Model

TMA:

Total skeletal muscle area

VCinfra:

Infrarenal inferior vena cava

VCR:

Inferior vena cava ratio

VCsupra:

Suprarenal inferior vena cava

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Antoine Wackenthaler and Sébastien Molière are contributed equally to the work

Authors and Affiliations

  1. Radiology Department, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Antoine Wackenthaler, Sébastien Molière & Francis Veillon

  2. Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France

    Sébastien Molière

  3. Hepatobiliary and Pancreatic Surgery, Endocrine and Liver Transplantation Department, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Thierry Artzner, Baptiste Michard, Pietro Addeo, Camille Besch, Philippe Bachellier & François Faitot

  4. Medical Intensive Care Department, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Thierry Artzner, Maleka Schenck & Francis Schneider

  5. Fédération de Médecine Translationnelle Strasbourg, Université de Strasbourg, Strasbourg, France

    Francis Schneider

  6. Laboratoire ICube, INSERM UMR7357, Université de Strasbourg, Strasbourg, France

    François Faitot

Authors
  1. Antoine Wackenthaler
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  10. Francis Veillon
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Corresponding author

Correspondence to Sébastien Molière.

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The scientific guarantor of this publication is François Faitot.

Statistics and biometry

One of the authors has significant statistical expertise.

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• Performed at one institution

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Wackenthaler, A., Molière, S., Artzner, T. et al. Pre-operative CT scan helps predict outcome after liver transplantation for acute-on-chronic grade 3 liver failure. Eur Radiol 32, 12–21 (2022). https://doi.org/10.1007/s00330-021-08131-1

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  • DOI: https://doi.org/10.1007/s00330-021-08131-1

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