Titre :

Long-term outcome following liver transplantation of patients with ACLF grade 3.

Auteur(s) :

Artru, Florent [Auteur]
Institute for Translational Research in Inflammation - U 1286 [INFINITE]
Sacleux, S. C. [Auteur]
Ursic-Bedoya, J. [Auteur]
Ntandja Wandji, Line [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Lutu, A. [Auteur]
L'hermite, S. [Auteur]
Levy, C. [Auteur]
Khaldi, M. [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Levesque, E. [Auteur]
Dharancy, S. [Auteur]
Boleslawski, E. [Auteur]
Lebuffe, Gilles [Auteur]
Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA) - ULR 7365
Le Goffic, C. [Auteur]
Ichai, P. [Auteur]
Coilly, A. [Auteur]
De Martin, E. [Auteur]
Vibert, E. [Auteur]
Meszaros, M. [Auteur]
Herrerro, A. [Auteur]
Monet, C. [Auteur]
Jaber, S. [Auteur]
Samuel, D. [Auteur]
Mathurin, P. [Auteur]
Labreuche, J. [Auteur]
Pageaux, G. P. [Auteur]
Saliba, F. [Auteur]
Hôpital Paul Brousse
Louvet, A. [Auteur]
Hôpital Claude Huriez [Lille]

Titre de la revue :

Journal of Hepatology

Nom court de la revue :

J Hepatol

Date de publication :

2024-07-11

ISSN :

1600-0641

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

Background & Aims Utility, a major principle for allocation in the context of transplantation, is questioned in patients with acute-on chronic liver failure grade 3 (ACLF-3) who undergo liver transplantation (LT). We aimed ...
Lire la suite >Background & Aims Utility, a major principle for allocation in the context of transplantation, is questioned in patients with acute-on chronic liver failure grade 3 (ACLF-3) who undergo liver transplantation (LT). We aimed to explore long-term outcomes of patients included in a three-centre retrospective French study published in 2017. Method All patients with ACLF-3 (n = 73), as well as their transplanted matched controls with ACLF-2 (n = 145), 1 (n = 119) and no ACLF (n = 292), who participated in the Princeps study published in 2017 were included. We explored 5- and 10-year patient and graft survival rates, causes of death and their predictive factors. Results Median follow-up of patients with ACLF-3 was 7.5 years. At LT, median MELD was 40. In patients with ACLF-3, 2, 1 and no ACLF, 5-year patient survival rates were 72.6% vs. 69.7% vs. 76.4% vs. 77.0%, respectively (p = 0.31). Ten-year patient survival for ACLF-3 was 56.8% and was not different to other groups (p = 0.37). Leading causes of death in patients with ACLF-3 were infections (33.3%) and cardiovascular events (23.3%). After exclusion of early death, UCLA futility risk score, age-adjusted Charlson comorbidity index and CLIF-C ACLF score were independently associated with 10-year patient survival. Long-term graft survival rates were not different across the groups. Clinical frailty scale and WHO performance status improved over time in patients alive after 5 years. Conclusion 5- and 10-year patient and graft survival rates were not different in patients with ACLF-3 compared to matched controls. 5-year patient survival is higher than the 50%-70% threshold defining the utility of a liver graft. Efforts should focus on candidate selection based on comorbidities, as well as the prevention of infection and cardiovascular events. Impact and implications While short-term outcomes following liver transplantation in the most severely ill patients with cirrhosis (acute-on-chronic liver failure grade 3 [ACLF-3]) are known, long-term data are limited, raising questions about the utility of graft allocation in the context of scarce medical resources. This study provides a favourable long-term update, confirming no differences in 5- and 10-year patient and graft survival following liver transplantation in patients with ACLF-3 compared to matched patients with ACLF-2, ACLF-1, and no-ACLF. The study highlights the risk of dying from infection and cardiovascular causes in the long-term and identifies scores including comorbidity evaluation, such as the age-adjusted Charlson comorbidity index, as independently associated with long-term survival. Therefore, physicians should consider the cumulative burden of comorbidities when deciding whether to transplant these patients. Additionally, after transplantation, the study encourages mitigating infectious risk with tailored immunosuppressive regimens and tightly managing cardiovascular risk over time.Lire moins >

Langue :

Anglais

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

Université de Lille
CHU Lille

Collections :

• Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA) - ULR 7365

Date de dépôt :

2024-09-06T21:10:31Z
2024-09-18T09:52:00Z