title: Artificial liver support system combined with liver transplantation in the treatment of patients with acute-on-chronic liver failure.
abstract: BACKGROUND
  The search for a strategy to provide temporary liver support and salvage the patients with acute-on-chronic liver failure (ACLF) remains an important issue. This study was designed to evaluate the experience in artificial liver support system (ALSS) combined with liver transplantation (LT) in the treatment of ACLF.
  
  
  RESULTS
  One hundred and seventy one patients with HBV related ACLF undergoing LT between January 2001 and December 2009 were included. Of the 171 patients, 115 received 247 sessions of plasma exchange-centered ALSS treatment prior to LT (ALSS-LT group) and the other 56 received emergency LT (LT group). The MELD score were 31±6 and 30±7 in ALSS-LT group and LT group. ALSS treatment resulted in improvement of liver function and better tolerance to LT. The average level of serum total bilirubin before LT was lower than that before the first time of ALSS treatment. The median waiting time for a donor liver was 12 days (2-226 days) from the first run of ALSS treatment to LT. Compared to LT group, the beneficial influences of ALSS on intraoperative blood loss and endotracheal intubation time were also observed in ALSS-LT group. The 1-year and 5-year survival rates in the ALSS-LT group and LT group were 79.2% and 83%, 69.7% and 78.6%.
  
  
  CONCLUSIONS
  Plasma exchange-centered ALSS is beneficial in salvaging patients with ACLF when a donor liver is not available. The consequential LT is the fundamental treatment modality to rescue these patients and lead to a similar survival rate as those patients receiving emergency transplantation.
authors.affiliation: Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Liu
authors.forename: Qi
authors.initials: Q
authors.lastname: Ling
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wei
authors.forename: Zhikun
authors.initials: Z
authors.lastname: Liu
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Xu
authors.forename: Lin
authors.initials: L
authors.lastname: Zhou
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
authors.forename: Jianrong
authors.initials: J
authors.lastname: Huang
authors.forename: Jifang
authors.initials: J
authors.lastname: Sheng
authors.forename: Shusen
authors.initials: S
authors.lastname: Zheng
authors.forename: Lanjuan
authors.initials: L
authors.lastname: Li
mesh_terms: D016063:Blood Loss, Surgical; D006801:Humans; D066298:In Vitro Techniques; D007362:Intensive Care Units; D017114:Liver Failure, Acute / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects; D019164:Liver, Artificial / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D012189:Retrospective Studies; D016019:Survival Analysis