title: Outcome after wait-listing for emergency liver transplantation in acute liver failure: a single centre experience.
abstract: OBJECTIVE
  Though emergency liver transplantation (ELT) is an established treatment for severe acute liver failure (ALF), outcomes are inferior to elective surgery. Despite prioritization, many patients deteriorate, becoming unsuitable for ELT.
  
  
  METHODS
  We examined a single-centre experience of 310 adult patients with ALF registered for ELT over a 10-year period to determine factors associated with failure to transplant, and in those patients undergoing ELT, those associated with 90-day mortality.
  
  
  RESULTS
  One hundred and thirty-two (43%) patients had ALF resulting from paracetamol and 178 (57%) from non-paracetamol causes. Seventy-four patients (24%) did not undergo surgery; 92% of these died. Failure to transplant was more likely in patients requiring vasopressors at listing (hazard ratio 1.9 (95% CI 1.1-3.6)) paracetamol aetiology (2.5 (1.4-4.6)) but less likely in blood group A (0.5 (0.3-0.9)). Post-ELT survival at 90-days and one-year increased from 66% and 63% in 1994-1999 to 81% and 79% in 2000-2004 (p<0.01). Four variables were associated with post-ELT mortality; age >45 years (3 (1.7-5.3)), vasopressor requirement (2.2 (1.3-3.8), transplantation before 2000 (1.9 (1.1-3.3)) and use of high-risk grafts (2.3 (1.3-4.2).
  
  
  CONCLUSIONS
  The data indicate improved outcomes in the later era, despite higher level patient dependency and greater use of high-risk grafts, through improved graft/recipient matching.
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK. william.bernal@kcl.ac.uk
authors.forename: William
authors.initials: W
authors.lastname: Bernal
authors.forename: Timothy J S
authors.initials: TJ
authors.lastname: Cross
authors.forename: Georg
authors.initials: G
authors.lastname: Auzinger
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sizer
authors.forename: Michael A
authors.initials: MA
authors.lastname: Heneghan
authors.forename: Matthew
authors.initials: M
authors.lastname: Bowles
authors.forename: Paulo
authors.initials: P
authors.lastname: Muiesan
authors.forename: Mohammed
authors.initials: M
authors.lastname: Rela
authors.forename: Nigel
authors.initials: N
authors.lastname: Heaton
authors.forename: Julia
authors.initials: J
authors.lastname: Wendon
authors.forename: John G
authors.initials: JG
authors.lastname: O'Grady
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000082:Acetaminophen / Q000506:poisoning; D000328:Adult; D000367:Age Factors; D004630:Emergencies; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D000017:ABO Blood-Group System; D000082:Acetaminophen