Liver transplantation in acute-on-chronic liver failure patients: a single center experience of 159 consecutive cases

Objective To evaluate the outcome of 1iver transplantation for acute-on-chronic liver failure (ACLF) patients. Methods We included 453 consecutive patients with previously cirrhosis who underwent liver transplantation between January 2013 and December 2017. Patients were categorized as no ACLF (n=294) and ACLF(n=159) according to EASL-CLIF consortium criteria. Furthermore, we used ACLF grades to categorize the ACLF patients. Their clinical data were reviewed and their 90-days survival outcomes were compared. Results Compared with the no ACLF group, the length of stay in the ICU was significantly prolonged for all patients with ACLF, and the 90-days survival rate after transplantation was significantly reduced in ACLF group. The length of stay in the ICU was shorter in Grade 1 and Grade 2 group when compared to Grade 3 group. The 90-days survival rate of no ACLF, Grade 1, Grade 2 and Grade 3 group were 93.20%, 92.59%, 93.33% and 73.68%, respectively. There were no statistically significant differences in 90-days survival rate among the no ACLF, Grade 1 and Grade 2 group. However, the 90-days survive rate of Grade 3 group was lower than that of other groups. Conclusions Liver transplantation has been shown to be safe and effective with good outcome in patients with ACLF and should be offered in early course of ACLF before onset of multi-organ failure. Key words: Acute-on-chronic liver failure; Liver transplantation; Outcome; Diagnosis criteria; Prognostic Score