Title :

Liver transplantation in the most severely ill cirrhotic patients: A multicenter study in acute-on-chronic liver failure grade 3

Author(s) :

Artru, Florent [Auteur]
Louvet, Alexandre [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Ruiz, Isaac [Auteur]
Levesque, Eric [Auteur]
Labreuche, Julien [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Ursic-Bedoya, Jose [Auteur]
Lassailly, Guillaume [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Dharancy, Sebastien [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Boleslawski, Emmanuel [Auteur]
Mécanismes de la Tumorigénèse et Thérapies Ciblées (M3T) - UMR 8161
Mécanismes de la Tumorigénèse et Thérapies Ciblées (M3T) - UMR 8161
Lebuffe, Gilles [Auteur]
Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA) - ULR 7365
Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA) - ULR 7365
Kipnis, Eric [Auteur]
Recherche translationnelle : relations hôte-pathogènes - EA 7366
Recherche translationnelle : relations hôte-pathogènes - EA 7366
Ichai, Philippe [Auteur]
Coilly, Audrey [Auteur]
De Martin, Eleonora [Auteur]
Antonini Teresa, Maria [Auteur]
Vibert, Eric [Auteur]
Jaber, Samir [Auteur]
Herrerro, Astrid [Auteur]
Samuel, Didier [Auteur]
Duhamel, Alain [Auteur]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Pageaux, Georges-Philippe [Auteur]
Mathurin, Philippe [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Saliba, Faouzi [Auteur]

Journal title :

Journal of hepatology

Abbreviated title :

J. Hepatol.

Volume number :

67

Pages :

708-715

Publication date :

2017-10-01

ISSN :

0168-8278

Keyword(s) :

Liver transplantation
Acute-on-chronic liver failure
Multi-organ dysfunction
Intensive care unit
Cirrhosis

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

BACKGROUND & AIMS: Liver transplantation (LT) for the most severely ill patients with cirrhosis, with multiple organ dysfunction (accurately assessed by the acute-on-chronic liver failure [ACLF] classification) remains ...
Show more >BACKGROUND & AIMS: Liver transplantation (LT) for the most severely ill patients with cirrhosis, with multiple organ dysfunction (accurately assessed by the acute-on-chronic liver failure [ACLF] classification) remains controversial. We aimed to report the results of LT in patients with ACLF grade 3 and to compare these patients to non-transplanted patients with cirrhosis and multiple organ dysfunction as well as to patients transplanted with lower ACLF grade. METHODS: All patients with ACLF-3 transplanted in three liver intensive care units (ICUs) were retrospectively included. Each patient with ACLF-3 was matched to a) non-transplanted patients hospitalized in the ICU with multiple organ dysfunction, or b) control patients transplanted with each of the lower ACLF grades (three groups). RESULTS: Seventy-three patients were included. These severely ill patients were transplanted following management to stabilize their condition with a median of nine days after admission (progression of mean organ failure from 4.03 to 3.67, p=0.009). One-year survival of transplanted patients with ACLF-3 was higher than that of non-transplanted controls: 83.9 vs. 7.9%, p<0.0001. This high survival rate was not different from that of matched control patients with no ACLF (90%), ACLF-1 (82.3%) or ACLF-2 (86.2%). However, a higher rate of complications was observed (100 vs. 51.2 vs. 76.5 vs. 74.3%, respectively), with a longer hospital stay. The notion of a "transplantation window" is discussed. CONCLUSIONS: LT strongly influences the survival of patients with cirrhosis and ACLF-3 with a 1-year survival similar to that of patients with a lower grade of ACLF. A rapid decision-making process is needed because of the short "transplantation window" suggesting that patients with ACLF-3 should be rapidly referred to a specific liver ICU. Lay summary: Liver transplantation improves survival of patients with very severe cirrhosis. These patients must be carefully monitored and managed in a specialized unit. The decision to transplant a patient must be quick to avoid a high risk of mortality.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
CHU Lille
CNRS
Inserm

Collections :

• Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA) - ULR 7365
• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
• Mécanismes de la Tumorigénèse et Thérapies Ciblées (M3T) - UMR 8161
• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
• Recherche translationnelle : relations hôte-pathogènes - ULR 7366

Research team(s) :

Innovation/évaluation des médicaments injectables
Inflammatory digestive disease : pathophysiology and therapeutic targets developement

Submission date :

2019-02-26T17:07:09Z