Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: To characterize the clinical course of patients diagnosed with acute on chronic liver failure (ACLF) before undergoing liver transplantation. ACLF is characterized by an acute decompensation, an elevated 28- and 90-day mortality rate, and extrahepatic organ failure. Current research suggests an exacerbated inflammatory immune response is the trigger to this syndrome, and that patients have both a dysfunctional systemic inflammatory and compensatory anti-inflammatory response that conditions a complex and severe clinical course.
*Methods: We identified patients from the National Institute of Medical Sciences and Nutrition Salvador Zubirán, in Mexico who were transplanted from 2015 to 2019. Patients were classified as compensated cirrhosis (CC), decompensated cirrhosis (DC) or ACLF, as per the EASL-CLIF definition. Their clinical course from the time of admission to when they received their liver transplant was analyzed. The number of ACLF events, duration, types of organ failure (OF) and their precipitating factors were recorded.
*Results: 239 patients received a liver transplant. Of those, 127 had DC, 92 had ACLF and 11 CC. ACLF patients were characterized by a severe clinical course with a large proportion of them having a final ACLF grade 2 or 3 (ACLF-2 37.6%, ACLF-3 36.6%, and ACLF-1 25.8%). Patients went in and out of ACLF criteria during the course of their disease and underwent several ACLF events; 44.1% (n=41) had one ACLF event, 34.4% (n=32) had two ACLF events, 16.1% (n=15) had three ACLF events, and only 10 (5.4%) of patients experienced more than 3 events. Median time from the first ACLF event to the day of LT was 65 (34-146) days and lasted a median time of 5 (2-14) days. At the first ACLF event, bacterial infections were the main precipitant (45.7%) followed by unknown precipitants in (34.4%). In the initial ACLF event, the most common OF was liver in 50.5% (n=47) of the patients, followed by kidney 43.0% (n=40), and circulation failure 31.2% (n=29). Brain failure was barely present at the initial ACLF event but increased significantly at the final ACLF grade (23.7%, p < 0.001).
*Conclusions: ACLF has a very dynamic course that worsens over time before reaching LT. Rapid intervention is critical due to the progression of ACLF grade which is often accompanied by a significant increase in brain failure (p < 0.001).
To cite this abstract in AMA style:Cervantes-Alvarez E, Lizardo-Thiebaud MJ, Alatorre-Arenas E, Mendez-Guerrero O, Yarza-Regalado S, Torre A, Vilatobá M, Kershenobich D, Huang CA, Navarro-Alvarez N. Acute on Chronic Liver Failure (ACLF) Patients Have a Dynamic and Progressive Clinical Course Until Receiving a Liver Transplant: A 5-Year Study at the National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/acute-on-chronic-liver-failure-aclf-patients-have-a-dynamic-and-progressive-clinical-course-until-receiving-a-liver-transplant-a-5-year-study-at-the-national-institute-of-medical-sciences-and-nutri/. Accessed January 19, 2021.
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