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
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
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
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
Sylvie Radenne
- Fonction : Auteur
- PersonId : 1269252
- ORCID : 0000-0001-7789-7264
- IdRef : 110051343
Jonel Trebicka
- Fonction : Auteur
- PersonId : 785930
- ORCID : 0000-0002-7028-3881
Lucy Meunier
- Fonction : Auteur
- PersonId : 761870
- ORCID : 0000-0001-5697-286X
Audrey Coilly
- Fonction : Auteur
- PersonId : 774218
- ORCID : 0000-0003-3149-8617
Magdalena Meszaros
- Fonction : Auteur
- PersonId : 792795
- ORCID : 0000-0002-5569-7285
Ioannis Petridis
- Fonction : Auteur
- PersonId : 813583
- ORCID : 0000-0003-0375-1523
Pietro Addeo
- Fonction : Auteur
- PersonId : 792789
- ORCID : 0000-0003-0046-7973
Camille Besch
- Fonction : Auteur
- PersonId : 779569
- ORCID : 0000-0002-7992-1595
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.