Long-term outcomes of emergency liver transplantation for acute liver failure.
Acute liver failure continues to be associated with a high mortality rate, and emergency liver transplantation is often the only life-saving treatment. The short-term outcomes are decidedly worse in comparison with those for nonurgent cases, whereas the long-term results have not been reported as extensively. We report our center's experience with urgent liver transplantation, long-term survival, and major complications. From 1994 to 2007, 60 patients had emergency liver transplantation for acute liver failure. The waiting list mortality rate was 6%. The mean waiting time was 2.7 days. Post-transplantation, the perioperative mortality rate was 15%, and complications included neurological problems (13%), biliary problems (10%), and hepatic artery thrombosis (5%). The 5- and 10-year patient survival rates were 76% and 69%, respectively, and the graft survival rates were 65% and 59%. Recipients of blood group-incompatible grafts had an 83% retransplantation rate. Univariate analysis by Cox regression analysis found that cerebral edema and extended criteria donor grafts were associated with worse long-term survival. Severe cerebral edema on a computed tomography scan pre-transplant was associated with either early mortality or permanent neurological deficits. The keys to long-term success and continued progress in urgent liver transplantation are the use of good-quality whole grafts and a short waiting list time, both of which depend on access to a sufficient pool of organ donors. Severe preoperative cerebral edema should be a relative contraindication to transplantation.
Chan
Gabriel
G
Multi-Organ Transplant Programme, London Health Sciences Centre, London, Ontario, Canada. gabrielk.chan@lhsc.on.ca
Taqi
Ali
A
Marotta
Paul
P
Levstik
Mark
M
McAlister
Vivian
V
Wall
William
W
Quan
Douglas
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000150:complications; D000075202:Contraindications; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017114:Liver Failure, Acute / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D009864:Ontario / Q000453:epidemiology; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult