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A Stepwise Evaluation of Hepatitis B Virus-Related Acute-on-Chronic Liver Failure to Optimize the Indication for Urgent Liver Transplantation

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Abstract

Background

Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a dynamic but reversible disease.

Aim

We aimed to clarify whether the change in Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH-ACLF) grade in HBV-ACLF patients can be used to predict prognosis, and to explore the appropriate conditions for performing urgent liver transplantation.

Methods

We assessed the COSSH-ACLF grades of HBV-ACLF patients at different time points from June 2013 to May 2019 at Huashan Hospital in Shanghai, China, and analyzed the relationship between the change in grade and patient prognosis.

Results

A total of 207 HBV-ACLF patients were enrolled, of which 79 underwent urgent liver transplantation. Their COSSH-ACLF grades were calculated at diagnosis, 3–7 days after diagnosis, and on the final day. Most of the final ACLF grades were consistent with their corresponding grades at days 3–7 after diagnosis (62.5%), while only 44.5% were in accordance with the initial grades at diagnosis. In patients who had a poor prognosis (initial ACLF-3 and ACLF-2 or -3 at days 3–7), the 28-day survival rate was 93.3% in those who underwent transplantation and 6.8% in those who did not (P < 0.0001). However, in patients who had a good prognosis (ACLF-0 or ACLF-1 at days 3–7), the 28-day survival rate was 100% in transplanted patients and 91.5% in non-transplanted patients (P = 0.236).

Conclusions

Reevaluation of the COSSH-ACLF grade 3–7 days after diagnosis could potentially show an indication for urgent liver transplantation.

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Acknowledgment

We would like to thank Brandi from Editage (www.editage.com) for English language editing.

Funding

We would like to thank the National Natural Science Foundation of China (No. 81670560) and National Science and Technology Major Project (2017ZX09304005, 2017ZX10202202) for their financial support.

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Authors and Affiliations

  1. Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China

    Xueyun Zhang, Yue Ying, Pu Zhou, Xiaoqin Liu, Minhui Dong, Beidi Zhu, Xun Qi, Jingwen Wu, Jianming Zheng, Wenhong Zhang, Jiming Zhang & Yuxian Huang

  2. Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Ruidong Li, Yifeng Tao, Xiaofei Zhang & Zhengxin Wang

  3. Department of Hepatology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201507, China

    Xun Qi & Qianqian Wang

  4. Department of Infectious Diseases, First Hospital Affiliated to Soochow University, Soochow, 215031, China

    Weifeng Zhao

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  1. Xueyun Zhang
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Correspondence to Yuxian Huang.

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Zhang, X., Ying, Y., Zhou, P. et al. A Stepwise Evaluation of Hepatitis B Virus-Related Acute-on-Chronic Liver Failure to Optimize the Indication for Urgent Liver Transplantation. Dig Dis Sci 66, 284–295 (2021). https://doi.org/10.1007/s10620-020-06149-x

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