• Philippe Ichai, Camille Legeai, Claire Francoz, Karim Boudjema, Olivier Boillot, Christian Ducerf, Philippe Mathurin, François-René Pruvot, Bertrand Suc, Philippe Wolf, Olivier Soubrane, Yves Patrice Le Treut, Daniel Cherqui, Laurent Hannoun, Georges-Philippe Pageaux, Jean Gugenheim, Christian Letoublon, Jean Saric, Vincent Di Martino, Armand Abergel, Laurence Chiche, Teresa Maria Antonini, Christian Jacquelinet, Denis Castaing, Didier Samuel, and French Liver Transplant Teams.
• Liver Intensive Care Unit, Centre Hepato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France; Unite 785, Inserm, Villejuif, France; Unités Mixtes de Recherche en Santé 785, Université Paris-Sud, Villejuif, France.
• Liver Transpl. 2015 Apr 1; 21 (4): 512-23.

AbstractIn France, decisions regarding superurgent (SU) liver transplantation (LT) for patients with acute liver failure (ALF) are principally based on the Clichy-Villejuif (CV) criteria. The aims of the present study were to study the outcomes of patients registered for SU LT and the factors that were predictive of spontaneous improvement and to determine the usefulness of the CV criteria. All patients listed in France for SU LT between 1997 and 2010 who were 15 years old or older with ALF were included. In all, 808 patients were listed for SU transplantation: 22% with paracetamol-induced ALF and 78% with non-paracetamol-induced ALF. Of these 808 patients, 112 improved spontaneously, 587 underwent LT, and 109 died or left the waiting list because of a worsening condition. The 1-year survival rate according to an intention-to-treat analysis and the survival after LT were 66.3% [interquartile range (IQR), 62.7%-69.7%] and 74.2% (IQR, 70.5%-77.6%), respectively. The factors that were predictive of a spontaneous recovery with ALF-related paracetamol hepatotoxicity were as follows: hepatic encephalopathy grade 0, 1, or 2 [odds ratio (OR), 4.8; 95% confidence interval (CI), 1.99-11.6]; creatinine clearance≥60 mL/minute/1.73 m2 (OR, 4.77; 95% CI, 1.96-11.63), a bilirubin level<200 µmol/L (OR, 21.64; 95% CI, 1.76-265.7); and a factor V level>20% (OR, 5.79; 95% CI, 1.66-20.29). For ALF-related nonparacetamol hepatotoxicity, the factor that was predictive of a spontaneous recovery was a bilirubin level<200 µmol/L (OR, 10.38; 95% CI, 4.71-22.86). The sensitivity, specificity, and positive and negative predictive values for the CV criteria were 75%, 56%, 50%, and 79%, respectively, for ALF due to paracetamol and 69%, 50%, 64%, and 55%, respectively, for ALF not related to paracetamol. The performance of current criteria for SU transplantation could be improved if paracetamol-induced ALF and non-paracetamol-induced ALF were split and 2 other items were included in this model: the bilirubin level and creatinine clearance.© 2015 American Association for the Study of Liver Diseases.

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