Long-term outcome following liver transplantation of patients with ACLF grade 3

Florent Artru  ¹ , Sophie-Caroline Sacleux  ² , Jose Ursic-Bedoya  ³ , Line Carole Ntandja Wandji  ⁴ , Alina Lutu  ² , Sebastien L’Hermite  ⁵ , Clementine Levy  ⁴ , Marion Khaldi  ⁴ , Eric Levesque  ⁶ , Sebastien Dharancy  ⁴ , Emmanuel Boleslawski  ⁴ , Gilles Lebuffe  ⁴ , Charles Le Goffic  ⁴ , Philippe Ichai  ² , Audrey Coilly  ² , Eleonora De Martin  ² , Eric Vibert  ² , Magdalena Meszaros  ³ , Astrid Herrerro  ³ , Clement Monet  ³ , Samir Jaber  ³ , Didier Samuel  ² , Philippe Mathurin  ⁴ , Julien Labreuche  ⁴ , Georges-Philippe Pageaux  ³ , Faouzi Saliba  ⁷ , Alexandre Louvet  ⁸

1. Hôpital Claude Huriez, CHU Lille, et université de Lille, Lille France; Service des maladies du foie, hôpital Pontchaillou, CHU Rennes, université de Rennes et institut NuMeCan Inserm U1241, Rennes Liver Failure Group RELIEF, Rennes, France.
2. Centre hépato-biliaire, CHU Paul Brousse, et université Paris-Saclay, Villejuif, France.
3. Hôpital Saint Eloi, CHU Montpellier, et université de Montpellier, Montpellier France.
4. Hôpital Claude Huriez, CHU Lille, et université de Lille, Lille France.
5. Service des maladies du foie, hôpital Pontchaillou, CHU Rennes, université de Rennes et institut NuMeCan Inserm U1241, Rennes Liver Failure Group RELIEF, Rennes, France.
6. Centre hépato-biliaire, CHU Paul Brousse, et université Paris-Saclay, Villejuif, France; CHU Tours, et université de Tours, Tours France.
7. Centre hépato-biliaire, CHU Paul Brousse, et université Paris-Saclay, Villejuif, France. Electronic address: faouzi.saliba@aphp.fr.
8. Hôpital Claude Huriez, CHU Lille, et université de Lille, Lille France. Electronic address: alexandre.louvet@chu-lille.fr.

This study investigates the long-term outcomes of liver transplantation (LT) in patients with acute-on-chronic liver failure grade 3 (ACLF-3) by analyzing data from a three-center retrospective French study. It included 73 ACLF-3 patients and matched controls with ACLF-2, ACLF-1, and no ACLF, exploring 5- and 10-year patient and graft survival rates. The results showed no significant differences in long-term survival between ACLF-3 patients and the other groups, with 5-year survival at 72.6% for ACLF-3 patients. The leading causes of death were infections and cardiovascular events. The study suggests that patient selection for LT should consider comorbidities, as indicated by scores like the age-adjusted Charlson Comorbidity Index, and emphasizes the importance of managing infection and cardiovascular risks post-transplantation. Despite the severity of ACLF-3, the findings support the utility of liver graft allocation in these patients, as their long-term outcomes are comparable to those with less severe conditions.

J Hepatol. 2024 Jul 7:S0168-8278(24)02346-8. doi: 10.1016/j.jhep.2024.06.039. Online ahead of print.

PMID: 38981560
DOI: 10.1016/j.jhep.2024.06.039