title: Patients with acute liver failure listed for superurgent liver transplantation in France: reevaluation of the Clichy-Villejuif criteria.
abstract: In France, decisions regarding superurgent (SU) liver transplantation (LT) for patients with acute liver failure (ALF) are principally based on the Clichy-Villejuif (CV) criteria. The aims of the present study were to study the outcomes of patients registered for SU LT and the factors that were predictive of spontaneous improvement and to determine the usefulness of the CV criteria. All patients listed in France for SU LT between 1997 and 2010 who were 15 years old or older with ALF were included. In all, 808 patients were listed for SU transplantation: 22% with paracetamol-induced ALF and 78% with non-paracetamol-induced ALF. Of these 808 patients, 112 improved spontaneously, 587 underwent LT, and 109 died or left the waiting list because of a worsening condition. The 1-year survival rate according to an intention-to-treat analysis and the survival after LT were 66.3% [interquartile range (IQR), 62.7%-69.7%] and 74.2% (IQR, 70.5%-77.6%), respectively. The factors that were predictive of a spontaneous recovery with ALF-related paracetamol hepatotoxicity were as follows: hepatic encephalopathy grade 0, 1, or 2 [odds ratio (OR), 4.8; 95% confidence interval (CI), 1.99-11.6]; creatinine clearance≥60 mL/minute/1.73 m2 (OR, 4.77; 95% CI, 1.96-11.63), a bilirubin level<200 µmol/L (OR, 21.64; 95% CI, 1.76-265.7); and a factor V level>20% (OR, 5.79; 95% CI, 1.66-20.29). For ALF-related nonparacetamol hepatotoxicity, the factor that was predictive of a spontaneous recovery was a bilirubin level<200 µmol/L (OR, 10.38; 95% CI, 4.71-22.86). The sensitivity, specificity, and positive and negative predictive values for the CV criteria were 75%, 56%, 50%, and 79%, respectively, for ALF due to paracetamol and 69%, 50%, 64%, and 55%, respectively, for ALF not related to paracetamol. The performance of current criteria for SU transplantation could be improved if paracetamol-induced ALF and non-paracetamol-induced ALF were split and 2 other items were included in this model: the bilirubin level and creatinine clearance.
authors: Liver Intensive Care Unit, Centre Hepato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France; Unite 785, Inserm, Villejuif, France; Unités Mixtes de Recherche en Santé 785, Université Paris-Sud, Villejuif, France.
authors: Philippe
authors: P
authors: Ichai
authors: Camille
authors: C
authors: Legeai
authors: Claire
authors: C
authors: Francoz
authors: Karim
authors: K
authors: Boudjema
authors: Olivier
authors: O
authors: Boillot
authors: Christian
authors: C
authors: Ducerf
authors: Philippe
authors: P
authors: Mathurin
authors: François-René
authors: FR
authors: Pruvot
authors: Bertrand
authors: B
authors: Suc
authors: Philippe
authors: P
authors: Wolf
authors: Olivier
authors: O
authors: Soubrane
authors: Yves Patrice
authors: YP
authors: Le Treut
authors: Daniel
authors: D
authors: Cherqui
authors: Laurent
authors: L
authors: Hannoun
authors: Georges-Philippe
authors: GP
authors: Pageaux
authors: Jean
authors: J
authors: Gugenheim
authors: Christian
authors: C
authors: Letoublon
authors: Jean
authors: J
authors: Saric
authors: Vincent
authors: V
authors: Di Martino
authors: Armand
authors: A
authors: Abergel
authors: Laurence
authors: L
authors: Chiche
authors: Teresa Maria
authors: TM
authors: Antonini
authors: Christian
authors: C
authors: Jacquelinet
authors: Denis
authors: D
authors: Castaing
authors: Didier
authors: D
authors: Samuel
mesh_terms: D000082:Acetaminophen; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D004630:Emergencies; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality
chemical_list: D000082:Acetaminophen