Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS) - Université de Montpellier Accéder directement au contenu
Article Dans Une Revue Journal of Hepatology Année : 2021

Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS)

Luca Belli (1) , Christophe Duvoux (2) , Thierry Artzner (3) , William Bernal (4) , Sara Conti (5, 6) , Paolo Cortesi (5, 6) , Sophie-Caroline Sacleux (7, 8) , George-Philippe Pageaux (9) , Sylvie Radenne (10) , Jonel Trebicka (11, 12) , Javier Fernandez (13, 14) , Giovanni Perricone (1) , Salvatore Piano (15) , Silvio Nadalin (16) , Maria Morelli (17) , Silvia Martini (18) , Wojciech Polak (19) , Krzysztof Zieniewicz (20) , Christian Toso (21) , Marina Berenguer (14, 22) , Claudia Iegri (23) , Federica Invernizzi (24) , Riccardo Volpes (25) , Vincent Karam (7) , René Adam (7) , François Faitot (26) , Liane Rabinovich (4) , Faouzi Saliba (7) , Lucy Meunier (9) , Mickael Lesurtel (10) , Frank Uschner (11) , Costantino Fondevila (13, 14) , Baptiste Michard (26) , Audrey Coilly (7) , Magdalena Meszaros (9) , Domitille Poinsot (10) , Andreas Schnitzbauer (11) , Luciano de Carlis (1) , Roberto Fumagalli (1) , Paolo Angeli (15) , Vincente Arroyo (12) , Rajiv Jalan (12) , Raffaella Viganò (1) , Chiara Mazzarelli (1) , Andrea Lauterio (1) , Alessandro Giacomoni (1) , Francesca Donato (27) , Pietro Lampertico (27) , Luisa Pasulo (23) , Stefano Fagiuoli (23) , Michele Colledan (23) , Maria Cristina Morelli (17) , Giovanni Vitale (17) , Damiano Patrono (28) , Renato Romagnoli (28) , Antonio Ottobrelli (28) , Ioannis Petridis (25) , Umberto Cillo (29) , Giacomo Germani (30) , Patrizia Burra (30) , Philippe Bachellier (26) , Pietro Addeo (26) , Camille Besch (26) , Sophie Caroline Sacleux (7) , Saliba Faouzi (7) , Didier Samuel (7) , Celine Guichon (10) , Stéfanie Faure (9) , Josè Ursic-Bedoya (9) , Jorde Colmenero (31) , David Toapanta (32) , María Hernández-Tejero (31) , Carmen Vinaixa (14, 22) , Caroline Den Hoed (19) , Jubi de Haan (19) , Andrea Della Penna (16) , Frank Erhard Uschner (11) , Martin Welker (11) , Stefan Zeuzem (11) , Wolf Bechstein (11) , Nicolas Goossens (21) , Joanna Raszeja-Wyszomirska (20) , Dev Katarey (33) , Banwari Agarwal (33)
1 ASST Great Metropolitan Niguarda / ASST Grande Ospedale Metropolitano Niguarda [Milan, Italia]
2 Hôpital Henri Mondor
3 Hôpital de Hautepierre [Strasbourg]
4 King‘s College London
5 Ospedale Multimedica Sesto San Giovanni
6 UNIMIB - Università degli Studi di Milano-Bicocca = University of Milano-Bicocca
7 CHB - Centre Hépato-Biliaire [Hôpital Paul Brousse]
8 Physiopathologie et traitement des maladies du foie
9 Département d'Hépato-Gastroentérologie et de Transplantation Hépatique [CHU Saint-Eloi]
10 Service d'Hépatologie [Hôpital de la Croix-Rousse - HCL]
11 Goethe-University Frankfurt am Main
12 EF CLIF - European Foundation for Study of Chronic Liver Failure [Barcelona]
13 IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer
14 CIBERehd - Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas
15 AOUP - Azienda Ospedale Università di Padova = Hospital-University of Padua
16 Universitätsklinikum Tübingen - University Hospital of Tübingen
17 AOUB - IRCCS Azienda Ospedaliero-Universitaria di Bologna
18 Azienda Ospedalerio - Universitaria Città della Salute e della Scienza di Torino = University Hospital Città della Salute e della Scienza di Torino
19 Erasmus MC - Erasmus University Medical Center [Rotterdam]
20 Medical University of Warsaw - Poland
21 Geneva University Hospitals and Geneva University
22 Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe
23 Hosp P Giovanni XXIII - Hospital Papa Giovanni XXIII
24 Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
25 ISMETT - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
26 Pôle des Pathologies Digestives Hépatiques et Transplantation [Hôpital Hautepierre-Strasbourg]
27 DEPT - Department of Physiopatology and Transplantation, University of Milan
28 Ospedale S. Giovanni Battista-Molinette
29 Azienda Ospedaliera di Padova
30 Unipd - Università degli Studi di Padova = University of Padua
31 SCReN - Hospital Clinic i Provincial de Barcelona
32 Hospital Clinic i Provincial de Barcelona (SCReN)
33 UCLH - University College London Hospitals

Résumé

Liver transplantation (LT) has been proposed as an effective salvage therapy even for the sickest patients with acute-on-chronic liver failure (ACLF). This large collaborative study was designed to assess the current clinical practice and outcomes of patients with ACLF who are wait-listed for LT in Europe. Methods: This was a retrospective study including 308 consecutive patients with ACLF, listed in 20 centres across 8 European countries, from January 2018 to June 2019. Results: A total of 2,677 patients received a LT: 1,216 (45.4%) for decompensated cirrhosis. Of these, 234 (19.2%) had ACLF at LT: 58 (4.8%) had ACLF-1, 78 (6.4%) had ACLF-2, and 98 (8.1%) had ACLF-3. Wide variations were observed amongst countries: France and Germany had high rates of ACLF-2/3 (27-41%); Italy, Switzerland, Poland and the Netherlands had medium rates (9-15%); and the United Kingdom and Spain had low rates (3-5%) (p <0.0001). The 1-year probability of survival after LT for patients with ACLF was 81% (95% CI 74-87). Pre-LT arterial lactate levels >4 mmol/L (hazard ratio [HR] 3.14; 95% CI 1.37-7.19), recent infection from multidrug resistant organisms (HR 3.67; 95% CI 1.63-8.28), and renal replacement therapy (HR 2.74; 95% CI 1.37-5.51) were independent predictors of post-LT mortality. During the same period, 74 patients with ACLF died on the waiting list. In an intention-to-treat analysis, 1-year survival of patients with ACLF on the LT waiting list was 73% for ACLF-1 or -2 and 50% for ACLF-3. Conclusion: The results reveal wide variations in the listing of patients with ACLF in Europe despite favourable post-LT survival. Risk factors for mortality were identified, enabling a more precise prognostic assessment of patients with ACLF.

Dates et versions

hal-03670454 , version 1 (17-05-2022)

Identifiants

Citer

Luca Belli, Christophe Duvoux, Thierry Artzner, William Bernal, Sara Conti, et al.. Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS). Journal of Hepatology, 2021, 75 (3), pp.610-622. ⟨10.1016/j.jhep.2021.03.030⟩. ⟨hal-03670454⟩
19 Consultations
0 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More