title: Liver transplantation for acute liver failure: are there thresholds not to be crossed?
abstract: Factors predicting survival after liver transplantation (LT) for irreversible acute liver failure (ALF) are rare. The aim of this study was to identify prognostic preoperative factors of patients with ALF that predict mortality after LT to avoid futile transplantation. From chart review, we identified 57 patients receiving transplants for ALF from 12/2000 to 09/2010. Recipient and donor data were analyzed and correlated with in-hospital mortality and patient survival by univariable/multivariable logistic regression and Cox proportional hazards. The survival rates at 30 days and 12 months were 77.2% and 64.9%, respectively. The in-hospital mortality rate was 29.8%. Follow-up of patients discharged from the hospital alive showed 30-day and 12-month survivals of 100% and 92.5%, respectively. Multivariable analysis of factors known preoperatively showed that the lowest pH of the recipient before LT (P = 0.03) was independently associated with in-hospital mortality, and the recipient's BMI (P = 0.03) and the lowest pH before LT (P = 0.03) were independently associated with patient survival. A pH of 7.26 was the calculated cutoff (ROC) for increased in-hospital mortality. Donor factors did not affect patient survival. Patients with ALF and a pH ≤ 7.26 have the worst outcome after liver transplantation. Therefore, emergency liver transplantation should be critically discussed for each individual.
authors.affiliation: Department for General, Visceral and Transplantation Surgery, Medical Center University Essen, Essen, Germany.
authors.forename: Dieter P
authors.initials: DP
authors.lastname: Hoyer
authors.forename: Martin
authors.initials: M
authors.lastname: Munteanu
authors.forename: Ali
authors.initials: A
authors.lastname: Canbay
authors.forename: Matthias
authors.initials: M
authors.lastname: Hartmann
authors.forename: Anja
authors.initials: A
authors.lastname: Gallinat
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Fuat H
authors.initials: FH
authors.lastname: Saner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006084:Graft Rejection; D006085:Graft Survival; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D019520:Living Donors / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
keywords: medical decision making; multivariable analysis; pH; preoperative assessment; risk factors