title: Liver transplantation in acute-on-chronic liver failure patients with high model for end-stage liver disease (MELD) scores: a single center experience of 100 consecutive cases.
abstract: BACKGROUND
  Acute-on-chronic liver failure (ACLF) is a severe clinical condition for which liver transplantation (LT) is the only curative option. However, there are little published data on risk factors and outcomes of LT for ACLF.
  
  
  METHODS
  The objective of this study was to analyze preoperative, intraoperative, postoperative, and overall survival data on 100 consecutive cases with ACLF in order to try to determine for which patients LT are futile.
  
  
  RESULTS
  One hundred consecutive patients with pathology-confirmed ACLF who underwent LT from June 2004 to September 2012 were enrolled. The preoperative data showed that all patients were in a serious condition with a median high model for end-stage liver disease (MELD) score of 32, total bilirubin of 440.20 umol/L, international normalized ratio (INR) of 3.012, and at least one organ dysfunction as assessed by a Sequential Organ Failure Assessment (SOFA) score of ≥9. The patients had either deceased or a living donor LT with an overall mortality of 20%. The 1-, 3-, and 5-year cumulative survival rates were 76.8%, 75.6%, and 74.1%, respectively, and graft 1-, 3-, and 5-y accumulative survival rates were 73.3%, 72.1%, and 70.6%, respectively. However, the area under receiver operating characteristic of SOFA score, MELD score, as well as Child-Pugh score were 0.552, 0.547, and 0.547, respectively.
  
  
  CONCLUSIONS
  Both deceased and living donor LT are effective therapeutic options for patients with ACLF and the short- and long-term survival rates are encouraging. It is important to conduct more prospective and multi-center studies to define preoperatively which patients would benefit from LT.
authors.affiliation: Department of Hepatobiliary Surgery and You-An Liver Transplant Center, Beijing You-An Hospital, Capital Medical University, Beijing, China.
authors.forename: Bin-Wei
authors.initials: BW
authors.lastname: Duan
authors.forename: Shi-Chun
authors.initials: SC
authors.lastname: Lu
authors.forename: Meng-Long
authors.initials: ML
authors.lastname: Wang
authors.forename: Jin-Ning
authors.initials: JN
authors.lastname: Liu
authors.forename: Ping
authors.initials: P
authors.lastname: Chi
authors.forename: Wei
authors.initials: W
authors.lastname: Lai
authors.forename: Ju-Shan
authors.initials: JS
authors.lastname: Wu
authors.forename: Qing-Liang
authors.initials: QL
authors.lastname: Guo
authors.forename: Dong-Dong
authors.initials: DD
authors.lastname: Lin
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.forename: Dao-Bing
authors.initials: DB
authors.lastname: Zeng
authors.forename: Chuan-Yun
authors.initials: CY
authors.lastname: Li
authors.forename: Qing-Hua
authors.initials: QH
authors.lastname: Meng
authors.forename: Hui-Guo
authors.initials: HG
authors.lastname: Ding
authors.forename: Xin-Yue
authors.initials: XY
authors.lastname: Chen
authors.forename: Hui-Yu
authors.initials: HY
authors.lastname: Liao
authors.forename: Lie-Qing
authors.initials: LQ
authors.lastname: Ma
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.forename: Hai-Ping
authors.initials: HP
authors.lastname: Xiang
authors.forename: Zhong-Ping
authors.initials: ZP
authors.lastname: Duan
authors.forename: Ning
authors.initials: N
authors.lastname: Li
mesh_terms: D000328:Adult; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome
keywords: Acute-on-chronic liver failure; Liver transplantation; Model for end-stage liver disease (MELD) score