Outcome after wait-listing for emergency liver transplantation in acute liver failure: a single centre experience.
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.
Bernal
William
W
Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK. william.bernal@kcl.ac.uk
Cross
Timothy J S
TJ
Auzinger
Georg
G
Sizer
Elizabeth
E
Heneghan
Michael A
MA
Bowles
Matthew
M
Muiesan
Paulo
P
Rela
Mohammed
M
Heaton
Nigel
N
Wendon
Julia
J
O'Grady
John G
JG
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
D000017:ABO Blood-Group System; D000082:Acetaminophen