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Predicting survival after living and deceased donor liver transplantation in adult patients with acute liver failure

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Post-transplant outcomes for acute liver failure (ALF) are unsatisfactory, and there are debates about the most suitable type of graft. Given the critical shortage of donor organs, accurate assessment of post-transplant outcome in ALF patients is crucial to avoid a futile liver transplantation (LT).

Methods

A database of 160 consecutive adult ALF patients who underwent primary LT between 2000 and 2009 in a tertiary LT center was analyzed.

Results

The most common causes of ALF were hepatitis B virus infection (30%) and herbal/folk medicine use (30%). Thirty-six (22.5%) and 124 (77.5%) patients underwent deceased-donor LT (DDLT) and adult-to-adult living-donor LT (LDLT), respectively. During a median follow-up period of 38 (range 1–132) months, the DDLT and LDLT groups showed similar patient (P = 0.99) and graft (P = 0.97) survival rates. The overall 1- and 3-year patient survival rates were 78.8 and 74.6%, respectively. Five predictors of patient survival were identified by bootstrapping and multivariate analysis: vasopressor requirement, estimated glomerular filtration rate, serum sodium concentration, recipient age, and donor age, at the time of transplant. By summing scores weighted in each of these predictor categories, we designed a prognostic scoring system (scores from −2 to 20) that estimated 1-year post-transplant mortality from 0 to 100% (c statistic 0.79).

Conclusions

Long-term outcomes after LDLT and DDLT were comparable in adult patients with ALF. A simple prognostic scoring system that includes 5 predictive variables at the time of LT may help estimate post-transplant survival in ALF patients, regardless of the type of transplant.

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Abbreviations

ALF:

Acute liver failure

APAP:

Acetaminophen

BMI:

Body mass index

DDLT:

Deceased-donor liver transplantation

ESLD:

End-stage liver disease

GFR:

Glomerular filtration rate

GRWR:

Graft-to-recipient weight ratio

HAV:

Hepatitis A virus

HBV:

Hepatitis B virus

HR:

Hazard ratio

INR:

International normalized ratio

IQR:

Inter-quartile range

KONOS:

Korean Network for Organ Sharing

LDLT:

Living-donor liver transplantation

LT:

Liver transplantation

MDRD:

Modification of diet in renal disease

MELD:

Model for end-stage liver disease

PH:

Proportional hazards

ROC:

Receiver operating characteristic

USN:

Ultrasonography

References

  1. Polson J, Lee WM. AASLD position paper: the management of acute liver failure. Hepatology. 2005;41:1179–97.

    Article  PubMed  Google Scholar 

  2. Ostapowicz G, Fontana RJ, Schiodt FV, Larson A, Davern TJ, Han SH, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002;137:947–54.

    PubMed  Google Scholar 

  3. Campsen J, Blei AT, Emond JC, Everhart JE, Freise CE, Lok AS, et al. Outcomes of living donor liver transplantation for acute liver failure: the adult-to-adult living donor liver transplantation cohort study. Liver Transplant. 2008;14:1273–80.

    Article  Google Scholar 

  4. Liu CL, Fan ST, Lo CM, Yong BH, Fung AS, Wong J. Right-lobe live donor liver transplantation improves survival of patients with acute liver failure. Br J Surg. 2002;89:317–22.

    Article  PubMed  CAS  Google Scholar 

  5. Uemoto S, Inomata Y, Sakurai T, Egawa H, Fujita S, Kiuchi T, et al. Living donor liver transplantation for fulminant hepatic failure. Transplantation. 2000;70:152–7.

    PubMed  CAS  Google Scholar 

  6. Park SJ, Lim YS, Hwang S, Heo NY, Lee HC, Suh DJ, et al. Emergency adult-to-adult living-donor liver transplantation for acute liver failure in a hepatitis B virus endemic area. Hepatology. 2010;51(3):903–11.

    PubMed  Google Scholar 

  7. Roberts MS, Angus DC, Bryce CL, Valenta Z, Weissfeld L. Survival after liver transplantation in the United States: a disease-specific analysis of the UNOS database. Liver Transplant. 2004;10:886–97.

    Article  Google Scholar 

  8. Burroughs AK, Sabin CA, Rolles K, Delvart V, Karam V, Buckels J, et al. 3-Month and 12-month mortality after first liver transplant in adults in Europe: predictive models for outcome. Lancet. 2006;367:225–32.

    Article  PubMed  Google Scholar 

  9. Polson J. Assessment of prognosis in acute liver failure. Semin Liver Dis. 2008;28:218–25.

    Article  PubMed  Google Scholar 

  10. Liou IW, Larson AM. Role of liver transplantation in acute liver failure. Semin Liver Dis. 2008;28:201–9.

    Article  PubMed  Google Scholar 

  11. Barshes NR, Lee TC, Balkrishnan R, Karpen SJ, Carter BA, Goss JA. Risk stratification of adult patients undergoing orthotopic liver transplantation for fulminant hepatic failure. Transplantation. 2006;81:195–201.

    Article  PubMed  Google Scholar 

  12. Bernal W, Cross TJ, Auzinger G, Sizer E, Heneghan MA, Bowles M, et al. Outcome after wait-listing for emergency liver transplantation in acute liver failure: a single centre experience. J Hepatol. 2009;50:306–13.

    Article  PubMed  Google Scholar 

  13. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–70.

    Article  PubMed  CAS  Google Scholar 

  14. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145:247–54.

    PubMed  CAS  Google Scholar 

  15. Sauerbrei W, Schumacher M. A bootstrap resampling procedure for model building: application to the Cox regression model. Stat Med. 1992;11:2093–109.

    Article  PubMed  CAS  Google Scholar 

  16. Sullivan LM, Massaro JM, D’Agostmo RB. Presentation of multivariate data for clinical use: The Framingham Study risk score functions. Stat Med. 2004;23:1631–60.

    Article  PubMed  Google Scholar 

  17. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.

    PubMed  CAS  Google Scholar 

  18. Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley; 2000.

    Book  Google Scholar 

  19. Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87.

    Article  PubMed  Google Scholar 

  20. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124:91–6.

    Article  PubMed  Google Scholar 

  21. Earl TM, Chari RS. Which types of graft to use in patients with acute liver failure? (A) Auxiliary liver transplant (B) Living donor liver transplantation (C) The whole liver. (C) I take the whole liver only. J Hepatol. 2007;46:578–82.

    Article  PubMed  Google Scholar 

  22. Hwang S, Lee SG, Ahn CS, Kim KH, Moon DB, Ha TY, et al. An increase in deceased donor incidence alleviated the need for urgent adult living donor liver transplantation in a Korean high-volume center. Transplant Proc. 2010;42:1497–501.

    Article  PubMed  CAS  Google Scholar 

  23. Bernal W, Wendon J, Rela M, Heaton N, Williams R. Use and outcome of liver transplantation in acetaminophen-induced acute liver failure. Hepatology. 1998;27:1050–5.

    Article  PubMed  CAS  Google Scholar 

  24. Bjoro K, Ericzon BG, Kirkegaard P, Hockerstedt K, Soderdahl G, Olausson M, et al. Highly urgent liver transplantation: possible impact of donor-recipient ABO matching on the outcome after transplantation. Transplantation. 2003;75:347–53.

    Article  PubMed  CAS  Google Scholar 

  25. Wigg AJ, Gunson BK, Mutimer DJ. Outcomes following liver transplantation for seronegative acute liver failure: experience during a 12-year period with more than 100 patients. Liver Transplant. 2005;11:27–34.

    Article  Google Scholar 

  26. Devlin J, Wendon J, Heaton N, Tan KC, Williams R. Pretransplantation clinical status and outcome of emergency transplantation for acute liver failure. Hepatology. 1995;21:1018–24.

    Article  PubMed  CAS  Google Scholar 

  27. Riordan SM, Williams R. Mechanisms of hepatocyte injury, multiorgan failure, and prognostic criteria in acute liver failure. Semin Liver Dis. 2003;23:203–15.

    Article  PubMed  CAS  Google Scholar 

  28. Gonwa TA, Jennings L, Mai ML, Stark PC, Levey AS, Klintmalm GB. Estimation of glomerular filtration rates before and after orthotopic liver transplantation: evaluation of current equations. Liver Transplant. 2004;10:301–9.

    Article  Google Scholar 

  29. Cocchetto DM, Tschanz C, Bjornsson TD. Decreased rate of creatinine production in patients with hepatic disease: implications for estimation of creatinine clearance. Ther Drug Monit. 1983;5:161–8.

    Article  PubMed  CAS  Google Scholar 

  30. Biggins SW, Kim WR, Terrault NA, Saab S, Balan V, Schiano T, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology. 2006;130:1652–60.

    Article  PubMed  Google Scholar 

  31. Lim YS, Larson TS, Benson JT, Kamath PS, Kremers WK, Therneau TM, et al. Serum sodium, renal function, and survival of patients with end-stage liver disease. J Hepatol. 2010;52:523–8.

    Article  PubMed  CAS  Google Scholar 

  32. Yun BC, Kim WR, Benson JT, Biggins SW, Therneau TM, Kremers WK, et al. Impact of pretransplant hyponatremia on outcome following liver transplantation. Hepatology. 2009;49:1610–5.

    Article  PubMed  CAS  Google Scholar 

  33. Dawwas MF, Lewsey JD, Neuberger JM, Gimson AE. The impact of serum sodium concentration on mortality after liver transplantation: a cohort multicenter study. Liver Transplant. 2007;13:1115–24.

    Article  Google Scholar 

  34. Londono MC, Guevara M, Rimola A, Navasa M, Taura P, Mas A, et al. Hyponatremia impairs early posttransplantation outcome in patients with cirrhosis undergoing liver transplantation. Gastroenterology. 2006;130:1135–43.

    Article  PubMed  Google Scholar 

  35. Simpson KJ, Bates CM, Henderson NC, Wigmore SJ, Garden OJ, Lee A, et al. The utilization of liver transplantation in the management of acute liver failure: comparison between acetaminophen and non-acetaminophen etiologies. Liver Transplant. 2009;15:600–9.

    Article  Google Scholar 

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Acknowledgments

The authors thank Drs. Ki-Hun Kim, Chul-Soo Ahn, Duk-Bog Moon, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Eunsil Yu, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Hwa Chung, and Yung Sang Lee for their help in data collection.

Conflict of interest

None of the authors have any potential conflicts of interest to disclose that are relevant to this manuscript, and the study was not funded by any commercial organization.

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Authors and Affiliations

  1. Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Young-Joo Jin, Young-Suk Lim & Han Chu Lee

  2. Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Seungbong Han

  3. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Shin Hwang & Sung Gyu Lee

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  1. Young-Joo Jin
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  2. Young-Suk Lim
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  4. Han Chu Lee
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  5. Shin Hwang
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Correspondence to Young-Suk Lim.

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Jin, YJ., Lim, YS., Han, S. et al. Predicting survival after living and deceased donor liver transplantation in adult patients with acute liver failure. J Gastroenterol 47, 1115–1124 (2012). https://doi.org/10.1007/s00535-012-0570-7

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  • DOI: https://doi.org/10.1007/s00535-012-0570-7

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