Liver transplantation in adults with acute liver failure: Outcomes from the Argentinean Transplant Registry
Introduction and aim: Liver transplantation (LT) for acute liver failure (ALF) still has a high early mortality. We aimed to evaluate changes occurring in recent years and identify risk factors for poor outcomes. Material and methods: Data were retrospectively obtained from the Argentinean Transplan...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-03-01
|
| Series: | Annals of Hepatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268119300134 |
| _version_ | 1818602885972230144 |
|---|---|
| author | Manuel Mendizabal Viviana Tagliafichi Fernando Rubinstein Paloma Rojas Sebastían Marciano Silvina Yantorno Nora Cejas Martín Barrabino Margarita Anders Fernando Cairo Federico Villamil Laura Blazquez Alina Zerega Sebastián Ferretti Diego Fernández Sebastián Paredes Gabriel Aballay Soteras Luis Gaite Liliana Bisigniano Marcelo O. Silva |
| author_facet | Manuel Mendizabal Viviana Tagliafichi Fernando Rubinstein Paloma Rojas Sebastían Marciano Silvina Yantorno Nora Cejas Martín Barrabino Margarita Anders Fernando Cairo Federico Villamil Laura Blazquez Alina Zerega Sebastián Ferretti Diego Fernández Sebastián Paredes Gabriel Aballay Soteras Luis Gaite Liliana Bisigniano Marcelo O. Silva |
| author_sort | Manuel Mendizabal |
| collection | DOAJ |
| description | Introduction and aim: Liver transplantation (LT) for acute liver failure (ALF) still has a high early mortality. We aimed to evaluate changes occurring in recent years and identify risk factors for poor outcomes. Material and methods: Data were retrospectively obtained from the Argentinean Transplant Registry from two time periods (1998–2005 and 2006–2016). We used survival analysis to evaluate risk of death. Results: A total of 561 patients were listed for LT (69% female, mean age 39.5 ± 16.4 years). Between early and later periods there was a reduction in wait-list mortality from 27% to 19% (p < 0.02) and 1-month post-LT survival rates improved from 70% to 82% (p < 0.01). Overall, 61% of the patients underwent LT and 22% died on the waiting list. Among those undergoing LT, Cox regression analysis identified prolonged cold ischemia time (HR 1.18 [1.02–1.36] and serum creatinine (HR 1.31 [1.01–1.71]) as independent risk factors of death post-LT. Etiologies of ALF were only available in the later period (N = 363) with indeterminate and autoimmune hepatitis accounting for 28% and 26% of the cases, respectively. After adjusting for age, gender, private/public hospital, INR, creatinine and bilirubin, and considering LT as the competing event, indeterminate etiology was significantly associated with death (SHR 1.63 [1.06–2.51] and autoimmune hepatitis presented a trend to improved survival (SHR 0.61 [0.36–1.05]). Conclusions: Survival of patients with ALF on the waiting list and after LT has significantly improved in recent years. Indeterminate cause and autoimmune hepatitis were the most frequent etiologies of ALF in Argentina and were associated with mortality. |
| first_indexed | 2024-12-16T13:14:24Z |
| format | Article |
| id | doaj.art-c2e95ba3fc23459e82b21ff9a5168cc9 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-12-16T13:14:24Z |
| publishDate | 2019-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-c2e95ba3fc23459e82b21ff9a5168cc92022-12-21T22:30:32ZengElsevierAnnals of Hepatology1665-26812019-03-01182338344Liver transplantation in adults with acute liver failure: Outcomes from the Argentinean Transplant RegistryManuel Mendizabal0Viviana Tagliafichi1Fernando Rubinstein2Paloma Rojas3Sebastían Marciano4Silvina Yantorno5Nora Cejas6Martín Barrabino7Margarita Anders8Fernando Cairo9Federico Villamil10Laura Blazquez11Alina Zerega12Sebastián Ferretti13Diego Fernández14Sebastián Paredes15Gabriel Aballay Soteras16Luis Gaite17Liliana Bisigniano18Marcelo O. Silva19Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN); Corresponding author at: Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Avenida Juan D. Perón 1500, B1629AHJ Pilar, Provincia de Buenos aires, Argentina.Instituto Nacional Central Unico Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, ArgentinaInstituto de Efectividad Clínica y Sanitaria, Buenos Aires, ArgentinaLiver Transplant Unit, Hospital El Cruce, Florencio Varela, Buenos Aires, ArgentinaLiver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, ArgentinaHepatology and Liver Transplant Program, Hospital Universitario Fundación Favaloro, Buenos Aires, ArgentinaLiver Transplant Program, Hospital Dr. Cosme Argerich, Buenos Aires, ArgentinaLiver Transplant Unit, Hospital Privado de Córdoba, Córdoba, ArgentinaHepatology and Liver Transplant Unit, Hospital Alemán, Buenos Aires, ArgentinaLiver Transplant Unit, Hospital El Cruce, Florencio Varela, Buenos Aires, Argentina; Liver Transplant Unit, Hospital Británico, Buenos Aires, ArgentinaLiver Transplant Unit, Hospital El Cruce, Florencio Varela, Buenos Aires, Argentina; Liver Transplant Unit, Hospital Británico, Buenos Aires, ArgentinaLiver Transplant Program, Hospital Italiano de Mendoza, Mendoza, ArgentinaLiver Transplant Unit, Sanatorio Allende, Córdoba, ArgentinaLiver Transplant Unit, Sanatorio Parque, Rosario, Santa Fe, ArgentinaLiver Transplant Program, Clínica Privada Pueyrredón, Mar del Plata, Buenos Aires, ArgentinaLiver Transplant Program, Hospital de Alta Complejidad “Juan D. Perón”, Formosa, ArgentinaLiver Transplant Program, Hospital Dr. Cosme Argerich, Buenos Aires, Argentina; Liver Transplant Unit, Sanatorio Mitre, Buenos Aires, ArgentinaLiver Transplant Program, Clinica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, ArgentinaInstituto Nacional Central Unico Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, ArgentinaHepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN)Introduction and aim: Liver transplantation (LT) for acute liver failure (ALF) still has a high early mortality. We aimed to evaluate changes occurring in recent years and identify risk factors for poor outcomes. Material and methods: Data were retrospectively obtained from the Argentinean Transplant Registry from two time periods (1998–2005 and 2006–2016). We used survival analysis to evaluate risk of death. Results: A total of 561 patients were listed for LT (69% female, mean age 39.5 ± 16.4 years). Between early and later periods there was a reduction in wait-list mortality from 27% to 19% (p < 0.02) and 1-month post-LT survival rates improved from 70% to 82% (p < 0.01). Overall, 61% of the patients underwent LT and 22% died on the waiting list. Among those undergoing LT, Cox regression analysis identified prolonged cold ischemia time (HR 1.18 [1.02–1.36] and serum creatinine (HR 1.31 [1.01–1.71]) as independent risk factors of death post-LT. Etiologies of ALF were only available in the later period (N = 363) with indeterminate and autoimmune hepatitis accounting for 28% and 26% of the cases, respectively. After adjusting for age, gender, private/public hospital, INR, creatinine and bilirubin, and considering LT as the competing event, indeterminate etiology was significantly associated with death (SHR 1.63 [1.06–2.51] and autoimmune hepatitis presented a trend to improved survival (SHR 0.61 [0.36–1.05]). Conclusions: Survival of patients with ALF on the waiting list and after LT has significantly improved in recent years. Indeterminate cause and autoimmune hepatitis were the most frequent etiologies of ALF in Argentina and were associated with mortality.http://www.sciencedirect.com/science/article/pii/S1665268119300134Latin AmericaFulminant hepatic failureAutoimmune hepatitisArgentina |
| spellingShingle | Manuel Mendizabal Viviana Tagliafichi Fernando Rubinstein Paloma Rojas Sebastían Marciano Silvina Yantorno Nora Cejas Martín Barrabino Margarita Anders Fernando Cairo Federico Villamil Laura Blazquez Alina Zerega Sebastián Ferretti Diego Fernández Sebastián Paredes Gabriel Aballay Soteras Luis Gaite Liliana Bisigniano Marcelo O. Silva Liver transplantation in adults with acute liver failure: Outcomes from the Argentinean Transplant Registry Annals of Hepatology Latin America Fulminant hepatic failure Autoimmune hepatitis Argentina |
| title | Liver transplantation in adults with acute liver failure: Outcomes from the Argentinean Transplant Registry |
| title_full | Liver transplantation in adults with acute liver failure: Outcomes from the Argentinean Transplant Registry |
| title_fullStr | Liver transplantation in adults with acute liver failure: Outcomes from the Argentinean Transplant Registry |
| title_full_unstemmed | Liver transplantation in adults with acute liver failure: Outcomes from the Argentinean Transplant Registry |
| title_short | Liver transplantation in adults with acute liver failure: Outcomes from the Argentinean Transplant Registry |
| title_sort | liver transplantation in adults with acute liver failure outcomes from the argentinean transplant registry |
| topic | Latin America Fulminant hepatic failure Autoimmune hepatitis Argentina |
| url | http://www.sciencedirect.com/science/article/pii/S1665268119300134 |
| work_keys_str_mv | AT manuelmendizabal livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT vivianatagliafichi livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT fernandorubinstein livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT palomarojas livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT sebastianmarciano livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT silvinayantorno livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT noracejas livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT martinbarrabino livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT margaritaanders livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT fernandocairo livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT federicovillamil livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT laurablazquez livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT alinazerega livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT sebastianferretti livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT diegofernandez livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT sebastianparedes livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT gabrielaballaysoteras livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT luisgaite livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT lilianabisigniano livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry AT marceloosilva livertransplantationinadultswithacuteliverfailureoutcomesfromtheargentineantransplantregistry |