• Jacqueline G O'Leary, Jasmohan S Bajaj, Puneeta Tandon, Scott W Biggins, Florence Wong, Patrick S Kamath, Guadalupe Garcia-Tsao, Benedict Maliakkal, Jennifer Lai, Michael Fallon, Hugo E Vargas, Paul Thuluvath, Ram Subramanian, Leroy R Thacker, and K Rajender Reddy.
• Dallas VA Medical Center, Dallas, TX.
• Liver Transpl. 2019 Apr 1; 25 (4): 571-579.

AbstractAcute-on-chronic liver failure (ACLF) characterized with ≥2 extrahepatic organ failures in cirrhosis carries a high mortality. Outcomes of patients listed for liver transplantation (LT) after ACLF and after LT are largely unknown. The North American Consortium for the Study of End-Stage Liver Disease prospectively enrolled 2793 nonelectively hospitalized patients with cirrhosis; 768 were listed for LT. Within 3 months, 265 (35%) received a LT, 395 remained alive without LT, and 108 died/delisted. Compared with nonlisted patients, those listed were younger and more often had ACLF, acute kidney injury, and a higher admission Model for End-Stage Liver Disease (MELD) score. ACLF was most common in patients who died/delisted, followed by those alive with and without LT respectively, (30%, 22%, and 7%, respectively; P < 0.001). At LT, median MELD was 27.9% and 70% were inpatients; median time from hospitalization to LT was 26 days. Post-LT survival at 6 months was unchanged between those with and without ACLF (93% each at 6 months). There was no difference in 3- and 6-month mean post-LT creatinine in those with and without ACLF, despite those with ACLF having a higher mean pre-LT creatinine and a higher rate of perioperative dialysis (61%). In conclusion, patients with and without ACLF had similar survival after transplant with excellent renal recovery in both groups.Copyright © 2019 by the American Association for the Study of Liver Diseases.

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