title: Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database.
abstract: OBJECTIVE
  Liver transplantation for acute liver failure (ALF) still has a high early mortality. We evaluated changes during 20 years, and identified risk factors for poor outcome.
  
  
  METHODS
  Donor, graft, and recipient variables from the European Liver Transplant Registry database (January 1988-June 2009), were analysed. Aetiologies and time periods were compared. Three and 12-month survival models were generated from separate training data sets, which were validated. A sub-analysis was performed for recipient older than 50 years.
  
  
  RESULTS
  Four thousand nine hundred and three patients were evaluated. One, 5- and 10-year patient, and graft survival rates were 74%, 68%, 63%, and 63%, 57%, 50%, respectively. Survival was better in 2004-2009 compared to previous quinquennia (p<0.001), despite donors >60 years increased from 1.8% to 21%. A higher incidence of suicide or non-adherence occurred in paracetamol-related ALF (p<0.001). Death or graft loss were independently associated with male recipients (adjusted OR 1.25), recipient >50 years (1.26), incompatible ABO matching (1.93), donors >60 years (1.21), and reduced size graft (1.54). For both 3- and 12-month models, incompatible ABO matching, non-viral aetiology, reduced size graft, and non-UW preservation fluid were associated with increased mortality/graft loss, whereas male recipients and age >50 years were associated only at 12 months. Both models had reasonable discriminative ability with good calibration at 3 months. Recipients >50 years, combined with donors >60 years resulted in 57% mortality/graft loss within the first year.
  
  
  CONCLUSIONS
  Survival after liver transplantation has improved despite increases in donor/recipient age. Recipients >50 years paired with donors >60 years had a very high mortality/graft loss within the first year.
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre, University Department of Surgery, Royal Free Hospital and UCL, London UK.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Germani
authors.forename: Eleni
authors.initials: E
authors.lastname: Theocharidou
authors.forename: Renè
authors.initials: R
authors.lastname: Adam
authors.forename: Vincent
authors.initials: V
authors.lastname: Karam
authors.forename: Julia
authors.initials: J
authors.lastname: Wendon
authors.forename: John
authors.initials: J
authors.lastname: O'Grady
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Marco
authors.initials: M
authors.lastname: Senzolo
authors.forename: Darius
authors.initials: D
authors.lastname: Mirza
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Jurgen
authors.initials: J
authors.lastname: Klempnauer
authors.forename: Stephen
authors.initials: S
authors.lastname: Pollard
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tsochatzis
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005060:Europe; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome