title: Liver transplantation for acute-on-chronic liver failure.
abstract: OBJECTIVE
  To evaluate the outcome of liver transplantation for acute-on-chronic liver failure.
  
  
  METHODS
  From November 1991 to December 2007, 517 patients underwent liver transplantation at Queen Mary Hospital, Hong Kong. Among them, 149 had acute-on-chronic liver failure as defined in the recent Asian Pacific Association for the Study of Liver Consensus Meeting. Their clinical data were reviewed and their survival outcomes were compared with those of patients who underwent liver transplantation for fulminant hepatic failure and for cirrhosis only in the same period.
  
  
  RESULTS
  The patients with acute-on-chronic liver failure included 50 patients having acute exacerbation of chronic hepatitis B and 99 cirrhotic patients with acute deterioration. Their median model for end-stage liver disease scores were 35 and 37, respectively. Preoperative infection (35%), hepatorenal syndrome (38%), and respiratory failure (28.8%) were common. One hundred and three patients received living donor liver grafts and 46 patients received deceased donor liver grafts. The hospital mortality rate was 4.7%. The 5-year survival rates were 93.2% for patients with acute exacerbation of chronic hepatitis B and 90.5% for cirrhotic patients with acute deterioration. The results were similar to those of the patients with fulminant hepatic failure (n = 37) and the patients having cirrhosis only (n = 301).
  
  
  CONCLUSIONS
  Liver transplantation for acute-on-chronic liver failure is life-saving, and the survival rates it attains are similar to those attained by transplantation for other liver conditions.
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Chan
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
authors.forename: Chi Leung
authors.initials: CL
authors.lastname: Liu
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Kelvin K
authors.initials: KK
authors.lastname: Ng
authors.forename: Boon Hun
authors.initials: BH
authors.lastname: Yong
authors.forename: Alexander
authors.initials: A
authors.lastname: Chiu
authors.forename: Banny K
authors.initials: BK
authors.lastname: Lam
references.citation: World J Surg. 2003 Mar;27(3):356-64
references.pmid: 12607066
references.citation: Hepatology. 2001 Feb;33(2):464-70
references.pmid: 11172350
references.citation: Br J Surg. 2003 Jan;90(1):48-56
references.pmid: 12520574
references.citation: Liver Int. 2006 Aug;26(6):695-702
references.pmid: 16842326
references.citation: Gastroenterology. 1989 Aug;97(2):439-45
references.pmid: 2490426
references.citation: Liver Transpl. 2000 May;6(3):296-301
references.pmid: 10827229
references.citation: Liver Transpl. 2004 Jun;10(6):728-33
references.pmid: 15162466
references.citation: Liver Transpl. 2007 Apr;13(4):509-15
references.pmid: 17394148
references.citation: Liver Transpl. 2003 Jun;9(6):575-80
references.pmid: 12783398
references.citation: Ann Surg. 2003 Jul;238(1):137-48
references.pmid: 12832976
references.citation: Hepatology. 1996 Jan;23(1):164-76
references.pmid: 8550036
references.citation: Clin Infect Dis. 2003 Apr 15;36(8):979-84
references.pmid: 12684909
references.citation: Hepatol Int. 2009 Mar;3(1):269-82
references.pmid: 19669378
references.citation: Transplant Proc. 2008 Oct;40(8):2492-3
references.pmid: 18929776
references.citation: Hepatology. 2002 Oct;36(4 Pt 1):949-58
references.pmid: 12297843