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)
,
Georges-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
(8)
,
René Adam
(8)
,
François Faitot
(26)
,
Liane Rabinovich
(4)
,
Faouzi Saliba
(7, 8)
,
Lucy Meunier
(9)
,
Mickaël Lesurtel
(10)
,
Frank Uschner
(11)
,
Costantino Fondevila
(13, 14)
,
Baptiste Michard
(26)
,
Audrey Coilly
(8)
,
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)
,
Didier Samuel
(8)
,
Celine Guichon
(10)
,
Stéfanie Faure
(9)
,
José Ursic-Bedoya
(9)
,
Jorde Colmenero
(31)
,
David Toapanta
(31)
,
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
(32)
,
Banwari Agarwal
(32)
1
ASST Grande Ospedale Metropolitano Niguarda [Milan]
2 Hôpital Henri Mondor
3 Hôpital de Hautepierre [Strasbourg]
4 King‘s College London
5 UNIMIB - Università degli Studi di Milano-Bicocca = University of Milano-Bicocca
6 Gruppo MultiMedica
7 Physiopathologie et traitement des maladies du foie
8 CHB - Centre Hépato-Biliaire [Hôpital Paul Brousse]
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 = Goethe-Universität 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 de Enfermedades Hepáticas y Digestivas = Biomedical Research Network Center for Liver and Digestive Diseases [Madrid]
15 AOUP - Azienda Ospedale Università di Padova = Hospital-University of Padua
16 Universitätsklinikum Tübingen = University Hospital of Tuebingen
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 Warszawski Uniwersytet Medyczny [Polska] = Medical University of Warsaw [Poland] = Université de Médecine de Varsovie [Pologne]
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 - The Mediterranean Institute for Transplantation and Highly Specialized Therapies [Palerme]
26 Pôle des Pathologies Digestives Hépatiques et Transplantation [Hôpital Hautepierre-Strasbourg]
27 DEPT - Department of Physiopatology and Transplantation, University of Milan
28 Presidio Ospedaliero Molinette [A.O.U. Città della Salute e della Scienza di Torino] = Molinette Hospital [Turin]
29 Azienda Ospedaliera di Padova
30 Unipd - Università degli Studi di Padova = University of Padua
31 Clinic Barcelona Hospital Universitari
32 UCLH - University College London Hospitals
2 Hôpital Henri Mondor
3 Hôpital de Hautepierre [Strasbourg]
4 King‘s College London
5 UNIMIB - Università degli Studi di Milano-Bicocca = University of Milano-Bicocca
6 Gruppo MultiMedica
7 Physiopathologie et traitement des maladies du foie
8 CHB - Centre Hépato-Biliaire [Hôpital Paul Brousse]
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 = Goethe-Universität 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 de Enfermedades Hepáticas y Digestivas = Biomedical Research Network Center for Liver and Digestive Diseases [Madrid]
15 AOUP - Azienda Ospedale Università di Padova = Hospital-University of Padua
16 Universitätsklinikum Tübingen = University Hospital of Tuebingen
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 Warszawski Uniwersytet Medyczny [Polska] = Medical University of Warsaw [Poland] = Université de Médecine de Varsovie [Pologne]
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 - The Mediterranean Institute for Transplantation and Highly Specialized Therapies [Palerme]
26 Pôle des Pathologies Digestives Hépatiques et Transplantation [Hôpital Hautepierre-Strasbourg]
27 DEPT - Department of Physiopatology and Transplantation, University of Milan
28 Presidio Ospedaliero Molinette [A.O.U. Città della Salute e della Scienza di Torino] = Molinette Hospital [Turin]
29 Azienda Ospedaliera di Padova
30 Unipd - Università degli Studi di Padova = University of Padua
31 Clinic Barcelona Hospital Universitari
32 UCLH - University College London Hospitals
Luca Belli
- Fonction : Auteur
- PersonId : 1273346
- ORCID : 0000-0001-8714-2439
Christophe Duvoux
- Fonction : Auteur
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William Bernal
- Fonction : Auteur
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Paolo Cortesi
- Fonction : Auteur
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Sophie-Caroline Sacleux
- Fonction : Auteur
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- ORCID : 0000-0003-4251-4563
Georges-Philippe Pageaux
- Fonction : Auteur
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Sylvie Radenne
- Fonction : Auteur
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- IdRef : 110051343
Jonel Trebicka
- Fonction : Auteur
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Javier Fernandez
- Fonction : Auteur
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- ORCID : 0000-0002-4862-2461
Giovanni Perricone
- Fonction : Auteur
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Salvatore Piano
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Wojciech Polak
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Christian Toso
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René Adam
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François Faitot
- Fonction : Auteur
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Faouzi Saliba
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Lucy Meunier
- Fonction : Auteur
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- ORCID : 0000-0001-5697-286X
Mickaël Lesurtel
- Fonction : Auteur
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Baptiste Michard
- Fonction : Auteur
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Audrey Coilly
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Magdalena Meszaros
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Andreas Schnitzbauer
- Fonction : Auteur
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Luciano de Carlis
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Paolo Angeli
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Andrea Lauterio
- Fonction : Collaborateur
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Francesca Donato
- Fonction : Collaborateur
Pietro Lampertico
- Fonction : Collaborateur
- PersonId : 1213635
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Maria Cristina Morelli
- Fonction : Collaborateur
Renato Romagnoli
- Fonction : Collaborateur
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Ioannis Petridis
- Fonction : Collaborateur
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Giacomo Germani
- Fonction : Collaborateur
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Patrizia Burra
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Philippe Bachellier
- Fonction : Collaborateur
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Pietro Addeo
- Fonction : Collaborateur
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- IdRef : 233051937
Camille Besch
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Didier Samuel
- Fonction : Auteur
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Stéfanie Faure
- Fonction : Collaborateur
José Ursic-Bedoya
- Fonction : Collaborateur
- PersonId : 786709
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- IdRef : 158344537
Caroline Den Hoed
- Fonction : Collaborateur
Andrea Della Penna
- Fonction : Collaborateur
Frank Erhard Uschner
- Fonction : Collaborateur
Martin Welker
- Fonction : Collaborateur
Stefan Zeuzem
- Fonction : Collaborateur
- PersonId : 1233654
- ORCID : 0000-0002-0845-6833
Wolf Bechstein
- Fonction : Collaborateur
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.