Liver transplantation in critically ill patients: Preoperative predictive factors of post-transplant mortality to avoid futility

Abstract : BACKGROUND: The allocation of liver transplants to patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) with multi-organ failure who are admitted in ICU remains controversial due to their high post-transplant mortality rate and the absence of identified mortality risk factors. METHODS: We performed a single-center retrospective cohort study to determine the post-transplant mortality rate of patients with ALF and ACLF requiring ICU care prior to liver transplant (LT) and identified pretransplant factors of post-transplant mortality. RESULTS: Eighty-four patients (29 with ALF and 55 with ACLF) received a liver transplant while they were hospitalized at the ICU. Their mean model for end-stage liver disease (MELD) score was 41, and their mean sequential organ failure assessment (SOFA) was 15 the day before transplant. The overall 1-year survival rate was 66%. In multivariate analysis, pretransplant lactate level and acute respiratory distress syndrome (ARDS) were the only two independent factors associated with post-transplant mortality. The absence of ARDS and a pretransplant lactate level< 5 mmol/L led to the identification of a subgroup of ICU patients with a good 1-year post-transplant survival (>80%). CONCLUSIONS: Low lactatemia lactate level and the absence of ARDS could be useful criteria in selecting those patients in ICU who could be eligible for liver transplant.
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Submitted on : Tuesday, January 15, 2019 - 5:51:08 PM
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Baptiste Michard, Thierry Artzner, Benjamin Lebas, Camille Besch, Max Guillot, et al.. Liver transplantation in critically ill patients: Preoperative predictive factors of post-transplant mortality to avoid futility. Clinical Transplantation, Wiley, 2017, 31 (12), pp.e13115. ⟨10.1111/ctr.13115⟩. ⟨inserm-01982604⟩

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