Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall C & D
*Purpose: Liver transplantation (LT) remains the gold standard treatment for acute liver failure (ALF). Our center has previously reported outcomes in the pre-Model for End Stage Liver Disease (MELD) era. We now sought to analyze changes in the etiology of ALF over time, and examine outcomes and their predictors in the post-MELD era.
*Methods: All patients transplanted for ALF at a single center, from Jan 2002-April 2018 were retrospectively reviewed. Survival analysis was performed using the Kaplan-Meier method. Predictors of graft and patient survival were calculated using Cox regression with STATA statistical software.
*Results: 214 patients underwent 222 LT’s for ALF during the study period. Median patient follow up was 65 months. The most common etiologies of ALF were cryptogenic (63; 28.4%), Tylenol (61; 27.5%), primary non-function (29; 13.1%), DILI (23; 10.4%), and Hepatitis B (13; 5.9%). 1, 5, and 10 year graft and patient survival were 80%, 72%, 67% and 82%, 75%, 71% respectively. While Pre-LT ventilator requirement, MELD >35 and donor age >45 years were significant predictors of inferior graft and patient survival on univariate analysis, graft survival was also adversely impacted by cerebral edema and Pre-LT dialysis (P<0.05). On multivariate analysis, ventilator requirement at time of transplant and donor age over 45 years were independent predictors of graft survival (HR 3.42, P-0.005, and HR 1.77, P-0.027, respectively) and patient survival (HR 4.76, P-0.004, and HR 1.95, P-0.019, respectively). Intracranial Pressure monitoring (ICPM) did not improve outcomes in patients with cerebral edema.
*Conclusions: This report represents one of the largest post-MELD single-center series examining LT for ALF in the U.S. Patient and graft survival in the post-MELD era have improved compared to the pre-MELD era, with 10 year patient survival exceeding 70%. Etiologies of ALF have changed, with fewer patients requiring LT for cryptogenic disease or Hepatitis A. The lack of ICPM efficacy in patients with cerebral edema and the identification of recipient and donor predictors of survival demonstrated in this analysis may inform patient management.
To cite this abstract in AMA style:McMillan R, Ito T, Aziz A, Amin A, Murray A, III JDiNorcia, Agopian VG, Yersiz H, Farmer DG, Busuttil RW, Kaldas FM. Liver Transplantation for Acute Liver Failure: A 16 Year Experience with 214 Patients in the Post-MELD Era [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/liver-transplantation-for-acute-liver-failure-a-16-year-experience-with-214-patients-in-the-post-meld-era/. Accessed July 3, 2020.
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